Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index

Abstract

Background Access to endovascular stroke centers (ESCs) is crucial for patients to receive optimal care for large‐vessel occlusion strokes. Disparities in stroke care are well documented, including differences in patients who receive intravenous thrombolysis and endovascular therapy. Here, we describe racial, ethnic, sex, and social disparities in access to ESCs using the Social Vulnerability Index (SVI), a composite measure of a community's health. Methods This is a population‐based study of 4 Northeastern states. We geocoded all ESCs in New York, New Jersey, Pennsylvania, and Delaware and calculated the distance from the centroid of each census tract to the nearest ESC. We then used the US Centers for Disease Control's Social Vulnerability Index and its 4 subcomponents to calculate the health of that census tract. Results are presented as mean drive times by quartile of SVI (quartile 1=least vulnerable, quartile 4=most vulnerable) and the mean SVI dichotomized to census tracts located less than and greater than 60 minutes to the nearest ESC. Results A total of 42 000 000 people and 10 000 census tracts were included in our data. There were no significant differences in the mean SVI for census with drive times of <60 minutes versus >60 minutes to the nearest ESC. However, there were significant differences in 2 subcomponents of the SVI: Minority Status & Language and Household Composition & Disability. In the Minority Status subcomponent of the SVI, those in the most vulnerable census tracts (quartile 4) were located closest to ESCs compared with the least vulnerable census tracts (quartile 1), while for the Household Composition subcomponent, the most vulnerable census tracts were located farthest from the ESCs. Conclusion The SVI is a valuable tool for assessing disparities in access to advanced stroke care and predicting where additional ESCs should be added to benefit the population as a whole.