Disclosures: Kansagra reports he received personal fees from iSchemaView, Microvention and Penumbra outside the submitted work. Please see the study for all other authors’ relevant financial disclosures. Mullen and Williams report no relevant financial disclosures.
June 10, 2021
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Proximity to certified stroke care longer for American Indian, uninsured individuals

Disclosures: Kansagra reports he received personal fees from iSchemaView, Microvention and Penumbra outside the submitted work. Please see the study for all other authors’ relevant financial disclosures. Mullen and Williams report no relevant financial disclosures.
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Disparities in race, ethnicity, health insurance, income and population density played a role in patient proximity to certified stroke care, researchers reported.

In both urban and rural tracts, elevated concentration of American Indian individuals and uninsured individuals was associated with farther distance from stroke centers, the researchers found.

Source: Adobe Stock
Source: Adobe Stock

Stroke patients have a much better chance of recovery if they can get to a stroke hospital quickly. The question we wanted to address was whether certain Americans have to travel farther than others to receive the expertise that might save them if they have a stroke,” Akash Kansagra, MD, MS, associate professor of radiology, neurological surgery and neurology at Washington University School of Medicine in St. Louis, said in a press release.

Researchers analyzed data from more than 316 million Americans by census tract from the U.S. Census Bureau’s 2014-2018 American Community Survey.

The study included 2,388 stroke hospitals in the continental U.S.

The researchers found that there was a significant difference in distance to the nearest stroke center between rural and urban locations.

Urban tracts

According to the researchers, 69% of the population was urban. Among individuals in urban tracts, 85% were aged 65 years or younger, 68% were white, 79% were non-Hispanic and 90% had medical insurance. The median annual income of the urban cohort was $31,027.

The researchers found that urban regions with higher numbers of American Indian individuals (0.1 km per 1% increase; 99.9% CI, 0.06-0.14) or uninsured populations (0.02 km per 1% increase; 99.9% CI, 0-0.03) had increased median distance to the nearest stroke hospital while elevated representation of Black, Asian and other races was associated with a reduced median distance.

No noticeable association was detected between representation of Pacific Islander population and distance to a stroke center, according to the researchers.

According to the researchers, in urban tracts, every $10,000 rise in median annual income was linked to a 0.166 km (99.9% CI, 0.104-0.229) increase in median distance to the nearest stroke hospital.

Nonurban tracts

According to the researchers, 31% of the people in the census tracts were nonurban. Among those individuals, 82% were aged 65 years or younger, 85% were white, 90% were non-Hispanic, 91% had health insurance and the median annual income was $29,058.

In nonurban tracts, areas with elevated levels of people aged at least 65 years (0.51 km per 1% increase; 99.9% CI, 0.42-0.59), American Indian individuals (1.06 km per 1% increase; 99.9% CI, 0.98-1.13) and uninsured individuals (0.27 km per 1% increase; 99.9% CI, 0.15-0.38) had a greater median distance from a certified stroke hospital, whereas increased representation of Black individuals was linked to shorter median distance.

According to the researchers, there was no apparent link between representations of Asian and other races and distance to a stroke center.

In nonurban tracts, every $10,000 increase in median annual income was associated with a decrease of 5.04 km (99.9% CI, 4.31-5.78) in median distance to the nearest stroke hospital, the researchers wrote.

“We believe that this work is important and highlights an ongoing need to evaluate developing systems of stroke care through an equity lens. Because of the proven effectiveness of acute stroke therapies and the potential for organized inpatient stroke care to reduce morbidity and mortality after stroke, equitable access to high-quality stroke care is critical to reducing disparities,” Michael T. Mullen, MD, MS, assistant professor of neurology at the Hospital of the University of Pennsylvania, and Olajide A. Williams, MD, MS, professor and chief of staff of the department of neurology at the Columbia University Vagelos College of Physicians and Surgeons and attending physician at NewYork-Presbyterian Hospital, wrote in an editorial.

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