Abstract 15: Stay at Home Orders During the Covid-19 Pandemic Associated With Race Ethnic Disparities in Patient Access to Healthcare for Stroke Like Symptoms

Abstract

Introduction: The COVID-19 pandemic has impacted stroke care and highlighted health care disparities. We aimed to determine if stroke alert (SA) volume, stroke alert mimic (SAM) volume, utilization of reperfusion therapies, and socioeconomic and race ethnic determinants of clinical outcome were impacted by the pandemic. Methods: Data was obtained from our Institutional Review Board approved SA database from February 2019-June 2019 and February 2020-June 2020 to capture the impact of the stay at home orders enacted at the end of March 2020 and the increase of COVID-19 cases in Florida in June 2020. Regression analysis was used to identify differences in volumes of SA, reperfusion therapy, SAM, and clinical factors (NIHSS, age, sex, race, ethnicity, insurance status, and rural region). Results: A total of 1171 SA were included, median age 66 (interquartile range 55-76), 50% woman, 23% Black, 68% Non-Hispanic White, 1% Hispanic, 8% unknown; 52% of the SA were SAM. SA volumes, thrombolysis and endovascular therapy use was unchanged. The volume of SAM did not differ between time intervals, but SAM were more likely to be older (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.02 - 1.04), White (OR 1.80, 95% CI 1.09 -2.99), uninsured (OR 2.19, 95% CI 1.35 - 3.46), arrive by EMS (OR 1.77, 95% CI 1.31- 2.40), and have a higher NIHSS (OR 1.02, 95% CI 1.003 - 1.034). SAM secondary to migraine, intoxication, medication toxicity, or psychiatric disease were less likely to occur in April 2020 (OR 0.37, CI 0.15- 0.96) and in patients from rural regions (OR 0.42, CI 0.19 - 0.95). They were more likely to occur in older patients (OR 1.06, CI 1.05-1.07) and men (OR 2.31, CI 1.62 - 3.31). SAM secondary to seizure were more likely to occur in April 2020 (OR 2.46, CI 1.06- 0.96) and Whites (OR 2.22, CI 1.16 -4.26). SAM from medical or non-cerebrovascular or epileptic neurologic disease were unchanged. Conclusions: Significant changes in the frequency of SAM subtypes occurred in close proximity to stay-at-home orders. Our findings suggest that a proportion of Blacks and Hispanics were not accessing healthcare for stroke like symptoms during the stay-at-home orders. Thus, patient education on how to access healthcare in vulnerable populations should be included with implementation of stay at home orders.