Abstract DP109: Geographic Disparities in Stroke Admissions in the United States Before&During the COVID-19 Pandemic: Regional, Institutional,&Monthly Trends

Importance: The COVID-19 pandemic disrupted stroke care systems across the U.S. Understanding regional differences, hospital-level variations in acute ischemic stroke (AIS) admissions&outcomes are crucial for future emergency preparedness&building resilient healthcare infrastructure. Objective&Methods: To assess the impact of the COVID-19 pandemic on regional stroke incidence, hospital status,&AIS admission patterns, as well as regional variations in AIS trends across the U.S. from 2016 to 2021. We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2021, analyzing adult AIS admissions (N = 3,165,154). U.S. regions, hospital types&monthly AIS admission rates were compared between the pre-pandemic period (2016–2019)&the peri-pandemic period (2020–2021). Incidence rates were estimated using U.S. Census population estimates. Results: From 2016 to 2021, AIS admissions were highest in the South&lowest in the West. Over the six years, a small increase in the South and a decrease in the Northeast, suggesting a shifting geographic burden of stroke (Table 1). AIS frequency among all hospitalizations peaked in 2019 (215 cases per 100,000 admissions), declined in 2020, partially rebounded in 2021 (205/100,000)&remained below the pre-pandemic peak. This pattern was consistent across all regions (Figure 1). The South consistently had the highest AIS incidence (up to 240/100,000 in 2019), whereas the West had the lowest (215/100,000 in 2020). Urban teaching hospitals accounted for an increasing majority of AIS admissions, rising from 66.4% in 2016 to 76.2% in 2021, while admissions to rural&urban non-teaching hospitals decreased (Table 1). Monthly trends showed a sudden drop in AIS admissions at the start of the pandemic in April 2020 (6.8% of annual AIS admissions), with January 2020 having the highest rate (9.4%; Figure 2). By 2021, admission patterns normalized to pre-pandemic levels, with peaks in March, June,&July (8.7% each; Figure 2). Conclusions: The pandemic amplified regional and institutional disparities in AIS care. Admissions shifted increasingly to urban teaching hospitals, highlighting reliance on high-capacity stroke centers. Although AIS incidence in the South declined slightly, it remained the highest nationally, reflecting ongoing disparities in the U.S. “Stroke Belt.” These findings underscore the need to strengthen stroke care infrastructure and ensure service continuity during public health crises.