Abstract W MP102: Disparities in Access to Primary Stroke Centers: Geography, Not Gender, Race, or Ethnicity

Abstract

Background: Primary Stroke Centers (PSCs) have lower mortality than non-PSCs. Disparities in access to PSCs could widen existing disparities in cerebrovascular disease. We examined whether the proportion of the US population with ≤ 60 minute access to PSCs varies based on geography, gender, race, or ethnicity. Methods: A cross-sectional geographic analysis of the US was conducted at the block group level (n=208,667). Prehospital time from the population weighted center of each block group to the nearest PSC (as of 12/31/10) via ground ambulance was estimated using validated prehospital time intervals and accounting for existing road networks. Neilsen-Claritas 2010 Census estimates were used to describe the population of each block group. The population with ≤ 60 minute access was calculated overall, and stratified by urbanicity (major cities, minor cities, suburbs, rural). Access was compared by stroke belt location (AL, AR, GA, LA, MS, NC, SC, TN vs. all other states), gender, race, and ethnicity. Results: There were 811 PSCs in the US on 12/31/2010. Of the 309 million people in the US, 65.8% had ≤ 60 minute PSC access by ground ambulance. The proportion of the population with PSC access ≤ 60 minutes was: 87% in major cities, 59% in minor cities, 9% in suburbs, and 1% in rural areas. PSC access was lower in stroke belt states, due to poor access in stroke belt cities (Table). Non-White and Hispanic individuals were more likely to have PSC access than Whites and non-Hispanics; there was no meaningful difference in access by gender (Table). Conclusions: There are significant geographic and demographic disparities in access to PSCs. Access is poor in suburban and rural areas. Despite the higher burden of cerebrovascular disease in stroke belt states, access to care is lower in these areas. Public policy and systems planning is needed to ensure acute stroke therapies are available in these areas.