Achieving the ‘golden hour’: evaluating and optimising the spatial distribution of comprehensive stroke centers in Liaoning Province, China

BACKGROUND: Efficient spatial layout of comprehensive stroke centers (CSCs) is crucial for the timely transport of stroke patients to hospitals for effective treatment following symptom onset. However, limited research has focused on the spatial allocation of CSCs. Therefore, this study aimed to evaluate the spatial distribution and accessibility of CSCs in Liaoning Province, China. METHODS: The closest-facility analysis and location-allocation model were employed to examine spatial accessibility, urban-rural disparities, and 1-hour coverage of the high-risk population under current and simulated CSC distribution scenarios. RESULTS: Key findings include: (1) CSC accessibility in Liaoning Province varies significantly, with better accessibility in major cities and poorer accessibility in mountainous and rural areas. (2) The existing 34 CSCs were mainly located in urban areas, and only 48.41% of townships and 60.63% of the high-risk population in Liaoning province can access them within 1 h. (3) In the optimization scenario, considering only candidate tertiary hospitals extended coverage to 75.63% of the high-risk populations. Integrating both candidate tertiary and secondary hospitals increased coverage in high-risk populations to 89.78%, effectively increasing the accessibility of CSCs, particularly in rural areas, and reducing the urban-rural accessibility gap. CONCLUSION: These insights shed light on the spatial disparities of CSCs in Liaoning Province and provide a spatial blueprint for establishing a "1-hour gold rescue circle". While improving geographic accessibility is a prerequisite, future policy should also prioritize the capacity building of candidate hospitals to ensure clinical efficacy.