Abstract TMP15: Rurality is Associated With Negative Social Determinants of Health and Worse Acute Stroke Metrics, for Patients With Large Vessel Occlusion

Abstract

Introduction: One-fifth of the US population reside in rural areas (RAs). Large vessel occlusion (LVO), a quarter of ischemic strokes, portends poor outcomes. Only select hospitals have mechanical thrombectomy (MT) capability, worsening stroke care access in under-resourced areas. Methods: With an integrated Get With the Guidelines and Institute for Health Metrics and Evaluation registry (2016-2019), we compared demographics, acute stroke metrics, and social determinants of health (SDH) for patients with LVO stroke residing in RAs to those residing in nonrural areas (NRAs). Rural-urban commuting area codes determined rurality. We used Pearson’s chi-squared test for categorical variables, and Student’s t-test for continuous variables. Results: Of 145,554 patients with LVO, 3% resided in RAs. Of 46,629 patients post-MT, 3% resided in RAs. Patients with LVO residing in RAs were less likely of female gender, Hispanic ethnicity, and more likely of White or Native-Hawaiian/Pacific-Islander race, than patients residing in NRAs (Table 1). They were more likely insured by Medicare, less by Medicaid, and less likely baseline ambulatory, have a Bachelor’s degree, or own a home, with lower median income. Patients with LVO residing in RAs more likely transferred into hospitals from other facilities than arrived from scene, less likely received thrombolysis, and had higher onset-to-arrival time. Door-to-needle time (DTNT) was lower for patients with LVO residing in RAs, but comparable specifically for patients undergoing MT (median (IQR) 38 (25) vs 35 (23), p=0.09), compared to patients residing in NRAs. Conclusions: Patients residing in RAs comprised a small portion of patients with LVO in the integrated registry, and differed demographically to patients residing in NRAs. Rurality was associated with negative SDH and worse acute stroke metrics, except DTNT for patients post-MT. Understanding rural stroke disparities may identify approaches to equity for patients with LVO.