Abstract 383: Racial Disparities in Stroke Care: Differences in Dispatch Pathways and Patient Location

Introduction Racial and ethnic disparities in stroke treatment are well‐documented, with Non‐Hispanic Black (NHB) and Hispanic patients often experiencing longer delays in care compared to Non‐Hispanic White (NHW) patients. This study evaluates differences in pre‐hospital metrics (dispatch pathway and dispatch location), both of which have potential to influence racial disparities in stroke management. Methods This retrospective cross‐sectional study included patients with acute stroke symptoms enrolled in BEST MSU, a cluster randomized trial with patients treated in Mobile Stroke Units (MSUs) or Emergency Medical Services (EMS) from August 2014 to August 2020. Patients were evaluated by EMS or MSU in alternating weeks. Data on race, ethnicity, education, insurance status, dispatch pathways (direct dispatch via patient/family via 911, on‐scene first responder, MSU monitoring EMS ratios and adding themselves onto call) dispatch locations (home, public area, chronic healthcare facility, and outpatient healthcare setting) were collected. We focused comparisons on NHB, NHW, and Hispanic patients. Variables were described using frequency and percentages. Results A total of 1,420 ischemic stroke patients were analyzed: NHW (n=557), NHB (n=277), and Hispanic (n=586). Hispanic patients had the highest uninsured rates (26.9% MSU, 37.9% EMS), followed by NHB patients (14.6% MSU, 13.2% EMS), while NHW patients had the lowest (3.4% MSU, 3.8% EMS). Hispanic patients also had the lowest educational attainment, with over 50% having less than a high school education, compared to 19.5% of NHB and 6.6% of NHW patients. NHW patients were the oldest group (median age: 74.0 MSU, 71.0 EMS), while NHB and Hispanic patients were younger (median age: 63 MSU, 63.5 EMS). Direct dispatch of MSU was more likely for NHW (54.8), compared to NHB (36.5) and Hispanic (43.5) patients (p<0.001). In contrast, NHB (50.2) and Hispanic (43.5) patients were more dependent on on‐scene first responders for MSU dispatch compared to NHW (34.6) patients. Regarding dispatch location, EMS/MSU was more likely to be called from “home” for NHW patients (48.3), and Hispanic patients (47.8%) compared to NHB (43.7%) patients. Dispatches for NHB patients most often came from public areas (49.5%). Conclusion Racial and ethnic differences in dispatch pathway and dispatch location exist. In BEST MSU, NHW patients were more likely to have direct dispatch of MSU to the home location. For NHB and Hispanic patients, MSU was dispatched by first responders. Finally, NHB patients enrolled in BEST MSU were more likely to be identified in public areas compared to home. More studies are needed to understand the possible reasons for these findings including differences in baseline demographic and social factors, disparities in stroke knowledge, or disparities in EMS utilization in BEST MSU. Further investigation is needed to understand whether these differences contribute to racial and ethnic disparities in treatment metrics and thrombolytic therapy utilization and to design targeted interventions to address these disparities.