Abstract WMP37: Neighborhood Socioeconomic Status, Race and Prehospital Emergency Care and Time to Presentation for Stroke

Abstract

Introduction: It is unclear how neighborhood socioeconomic status (nSES) affects the pre-hospital recognition and care of acute stroke at the national level. Methods: Patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset <24 hours were included. Social deprivation index (SDI) at the county level approximated nSES. Logistic and quantile regressions evaluated the impact of SDI on EMS use, EMS prenotification, and time of symptom onset to emergency department (ED) arrival. Sequential models were adjusted for patient age, gender, race, vascular risk factors, arrival mode, stroke severity (NIHSS), and insurance status. Results: 634,823 patients met inclusion criteria. Patients were 51.2% Male, 67.1% White, with median NIHSS of 4 (IQR: 2-10), and median SDI of 51 (IQR: 27-75). Median symptom onset to arrival time was 176 mins (IQR: 63-565). SDI was not associated with differences in EMS use, but was associated with lower odds of EMS prenotification (upper SDI tercile vs lowest, OR 0.87, 95% CI 0.86-0.89). SDI was also significantly associated with stroke symptom onset to ED arrival time (upper SDI tercile vs lowest +2.72 mins, 95% CI 0.68-4.77); however, this association became nonsignificant when insurance was added to the model. By contrast, Black race was significantly associated with prolonged symptom onset to ED arrival time (+28.7 mins, 95% CI 26.0-31.5), and decreased odds of EMS prenotification OR 0.76 (95% CI 0.74-0.77). Conclusions: Higher SDI was associated with reduced odds of EMS prenotification, despite similar odds of EMS use across SDI levels. Race had a greater effect, with prolonged prehospital times and decreased odds of EMS pre-notification. Efforts to reduce place-based disparities in stroke care must address significant race-based inequities which exist in pre-hospital recognition and care of stroke.