Abstract TMP89: Examining The Impact Of Area Deprivation On Patient Outcomes In LVO AIS

Abstract

Intro & Background: The Area Deprivation Index (ADI) is a validated neighborhood-level measure that utilizes variables such as income, education, and employment to quantify relative socioeconomic disadvantages. Here we explore the impact of disparities on EVT access. Methods & Materials: From our prospectively maintained multi-hospital registry, we identified patients with LVO AIS from January 2019- June 2020. Patient addresses and zip-codes were validated using US Postal Service codes and matched to census-tract level ADI scores that were obtained from Neighborhood Atlas. ADI were categorized into high and low using the median ADI as the cutoff. The primary outcome was utilization of EVT and IV tPA and was determined using multivariable logistic regression and expressed as OR [95% CI]. All p-values are two-sided with p<0.05 defined as statistically significant. All analyses were conducted using RStudio (Version 1·2·5001). Results: Among 637 patients with LVO AIS, median age was 68, 46% were female, 53% were white, 27% were black, and 78% identified as Hispanic. Median state ADI was 5 IQR [5]. NIHSS was similar between low/high ADI (mean(SD): 13.3(7.75) vs 13.6(8.62), p-value 0.69) regions. ADI was significantly associated with race (6.41 vs 4, black vs. white, p-value 0.03). In the univariable analysis, patients treated with EVT had lower mean ADIs (5.2 vs. 4.6, no EVT vs. EVT, p<0.02). In multivariable analysis adjusted for age, sex, race, ethnicity and NIHSS, higher ADI was significantly associated with greater rates of IV tPA usage (OR 1.7 [1.01-2.98]) but not EVT usage (OR 0.63 [0.04-1.0]) Conclusion: Patients residing in disadvantaged neighborhoods may have reduced rates of reperfusion therapy, despite comparable acute stroke presentation symptoms. These findings are consistent with prior studies demonstrating poorer health outcomes in these populations.