Abstract WMP2: Neighborhood Socioeconomic Disadvantage Drives Inequities In Thrombolytic Therapy For Patients With Acute Ischemic Stroke

Abstract

Background: The role of neighborhood socioeconomic disadvantage as a barrier to utilization of thrombolytic therapies among acute ischemic strokes (AIS) patients is not well characterized. Methods: Using data from 7 comprehensive and primary stroke centers across a diverse metropolitan, we analyzed intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy (MT) utilization rates among AIS patients across various levels of Area Deprivation Index (ADI). Exact patient addresses were geocoded, and state-level ADI ranks (1 - 10) were calculated. Multivariable logistic regression models were fitted to evaluate the association between high ADI and thrombolytic therapy (tPA and/or MT vs no tPA or MT). Among the treated, Last Known Well to Treatment Time (LKNW-TT) across ADI ranks was analyzed. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Between May 2016 and Apr 2021, a total of 2,900 AIS patients with complete data were included (mean age: 68.5 years, 49.9% female, 58.4% White, 12.9% Hispanic, median [IQR] ADI rank: 4 [2-7]). The overall treatment utilization rate was 35% (tPA only: 16.7%; MT with/without tPA: 18.3%). In a fully adjusted model, higher ADI was independently associated with lower likelihood of overall treatment (OR, CI: 0.93, 0.89-0.96), treatment with tPA alone (OR: 0.95, CI: 0.91-0.99) and utilization of MT (OR: 0.90, CI: 0.85-0.95) (Figure). LKNW-TT among tPA-treated patients was longer for those residing in top 50% of ADI neighborhoods (highest vs lowest 50 th percentile ADI rank) - median [IQR] minutes: 135 [86-179] vs 122 [90-180]. No differences for MT were observed: 268 [188-544] vs 270 [199-460] minutes. Conclusion: Socioeconomic disadvantage may lead to lower utilization of thrombolytic therapies among AIS patients, potentially driven by delayed presentation or treatment. Targeted educational and awareness efforts are needed among disadvantaged populations to equitably improve stroke outcomes.