Abstract Body: Background. The US Centers for Disease Control and Prevention’s (CDC) Paul Coverdell National Acute Stroke Program (PCNASP) supports state-based efforts to enhance stroke care quality. As part of the PCNASP, Kentucky developed an integrated system linking prehospital Emergency Medical Services and hospital-level data through the American Heart Association’s Get With The Guidelines^®- Stroke program. To help guide efforts to optimize stroke care processes and reduce disparities, we compared acute poststroke mortality in PCNASP-participating hospitals according to the patient’s county of residence for those residing in CDC-identified low and high stroke mortality counties and based on the county’s level of social deprivation.

Methods. County-level stroke mortality data (2018-2020) from the CDC and in-hospital data (2021-2023) from PCNASP-participating hospitals were analyzed. The patients’ counties of residence were classified based on CDC stroke mortality rates (high mortality, >80.4 per 100,000 population) and Social Deprivation Index (SDI) score tertile. Mixed effects models assessed the relationships between county mortality risk, SDI, and hospital-based stroke mortality.

Results. There was no difference in age standardized in-hospital mortality between patients residing in high (n=71; 18.3+17.9 per 100,000 population) compared to low (n=49; 18.8+16.6 per 100,000 population, p=.831) mortality counties or among counties with varying SDI scores (p=.117). Patients residing in higher SDI counties had higher rates of discharge to hospice. Overall, in-hospital mortality decreased between 2021-2023.

Conclusions. We found that patient-level acute stroke mortality rates in PCNASP participating hospitals do not mirror the mortality rates or degree of social deprivation in their county of residence. This suggests that expected differences in stroke mortality are mitigated for those who obtain acute care in PCNASP participating hospitals. To reduce stroke-related disparities, public health strategies should focus on promoting stroke prevention, public awareness, and facilitating access to high-quality care.