Abstract TP295: Neighborhood Factors are Associated With Strokes but Not EMS Utilization in Chicago

Abstract

Introduction: Neighborhood factors, such as income level and crime, may be risk factors for stroke and barriers to emergency medical services (EMS) utilization. We sought to identify neighborhoods with high rates of stroke and low EMS utilization and investigate neighborhood factors that influence these patterns. Methods: We conducted an analysis of confirmed stroke patients in Get with the Guidelines-Stroke database from 15 Chicago hospitals between Jan 2, 2013 and Jun 23, 2017. We included records with documented primary diagnosis of stroke, patient ZIP code, and mode of arrival. ArcGIS Pro 2.1.2 (Esri Inc., Redlands, CA) was used for analysis. We acquired ZIP code-level median age, median household income, insurance status, percentage white, percentage black, percentage Hispanic, and crime using U.S. Census Bureau American FactFinder database and City of Chicago Data Portal database. Using geographically-weighted regression, we estimated variance in stroke rates and EMS utilization for stroke associated with these neighborhood factors. Results: From 2013-2017, there were 10,040 stroke hospitalizations (Figure A) among which 47.7% arrived by EMS (Figure B). Approximately 79% of the variance in stroke hospitalizations in Chicago was explained by median household income and percentage of black residents. EMS use was modestly explained by percentage of white residents and median household income (maximum R-squared: 0.27). Crime and insurance rates were not associated with stroke or EMS use. Conclusions: Neighborhood factors are strong determinants of stroke hospitalization but not EMS utilization for stroke in Chicago. While socioeconomic status is relevant for stroke incidence, it has a small effect on EMS use. Patient-level factors that influence EMS use for stroke should be further explored.