Abstract 74: Area Deprivation Index, Stroke Outcomes, And Structural Changes To Improve Access To Thrombectomy

Abstract

Introduction: In New York City (NYC), expanding the reach of thrombectomy-capable stroke centers (TSC) is key to combating socioeconomic disparities in stroke care. The Area Deprivation Index (ADI), a validated, neighborhood-level composite measure (scored 1-100) that includes income, education, employment, and housing quality, has informed healthcare delivery but has not been used to identify disadvantaged neighborhoods with poor access to stroke care. We sought to evaluate the impact of establishing Mount Sinai Queens Hospital (MSQ) as a TSC in 2017 on transfer times and to explore the association between ADI and stroke care access. Methods: Thrombectomy patient pick-up addresses were obtained through Emergency Medical Services runsheets from June 2016 to July 2021 and matched to census-tract level ADI scores from Neighborhood Atlas. Preliminary analyses compared both ADIs and time to stroke care access in both Queens and Manhattan. The primary outcome measure was the duration between ambulance arrival and groin puncture. Simple linear regression and T-tests were used to assess the association between ADI and time to groin puncture by borough. Results: Among 517 cases between 2016-2021, the average ADI of pick-up locations was 10.35 (range: 1 - 70.5). Across all centers, higher ADI (greater deprivation) was significantly associated with increased time to groin puncture (p = 0.024). Notably, Queens patients were picked up in census tracts with higher ADI (p=0.0289) but had a faster pick up to groin puncture time (p=0.006). Conclusions: Across urban census tracts, a higher ADI was associated with delays in access to thrombectomy. Thrombectomy centers in areas with higher ADI can play a role in reducing healthcare disparities for stroke patients.

Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke

“…For instance, in one study, higher ADI was associated with longer times from ambulance arrival to groin puncture for thrombectomy. 27 Another study in South Korea also found that neither low area-level socioeconomic status nor urbanization was associated with prehospital delay; however, low socioeconomic status in urban areas was related to delay. 28 The latter study, unlike ours, did not account for distance to treating hospital and generalizability to the US sociodemographic landscape may be limited.…”