Abstract 277: Examining the Impact of Area Deprivation on Endovascular Stroke Therapy Access

Intro & Background Equitable access to healthcare is heavily impacted by socioeconomic factors, however, the effects of such disparities in accessing life‐saving stroke treatments remain incompletely characterized. Here we explore the impact of disparities on access to endovascular treatments for large vessel occlusion acute ischemic stroke (LVO AIS). Methods & Materials From our prospectively maintained multi‐hospital registry of four Comprehensive Stroke Centers, we identified patients 18 years or older with LVO AIS from January 2019‐ June 2020. Patient addresses and zip codes were matched to census‐tract level area deprivation index (ADI) scores obtained from Neighborhood Atlas (U. Of Wisconsin). ADI is a validated neighborhood‐level measure that utilizes variables such as income, education, and employment to quantify the level of deprivation in an area. The primary outcome was utilization of endovascular thrombectomy (EVT) by ADI quartile, adjusted for age, ASPECTS, and NIHSS, and was determined using multivariable logistic regression and expressed as OR [95% CI]. Results Among 637 patients with LVO AIS, the median age was 68, 46% were female, 64% were white, 28% were black, and 19% identified as Hispanic. Median ADI was 57 IQR [32‐78]. Notably, non‐Hispanic Black (NH‐Black) patients had the largest proportion 48.9% (N=66) of those with the highest ADI scores ranging from 79‐100. Comparatively, non‐Hispanic White (NH‐White) patients represented the largest population 67.7% (N=84), of those with the lowest ADI scores of ≤31. Greater ADI scores were associated with a higher prevalence of stroke risk factors, including hypertension, type 2 diabetes, prior stroke, and hyperlipidemia. NIHSS, pMRS, ASPECTS, final TICI scores, 90‐day disability outcomes, and discharge disposition were comparable across the ADI quartiles. In the univariable analysis, patients with AIS LVO in greater ADI neighborhoods were less likely to undergo EVT (61% vs 67% vs 61% vs. 50%, ADI quartiles least to greatest respectively, p=0.01). In the multivariable analysis adjusted for age, ASPECTS, and NIHSS [1], higher ADI regions were less likely to receive EVT intervention (OR 0.73, 95% CI (0.59‐0.91), p<0.01). Conclusion Patients residing in disadvantaged neighborhoods (greater ADI regions) may have reduced access to EVT, despite comparable acute stroke presentation symptoms. These findings are consistent with prior studies demonstrating poorer health outcomes in these populations.