Abstract Body: Introduction: Significant strides have been made in optimizing thrombolysis and thrombectomy for acute ischemic stroke treatment. However, available treatment options and better patient outcomes favor stroke patients with hospital arrivals within earlier time frames relative to symptom onset. Socioeconomic status (SES) may impact arrival times and contribute to disparities in treatment rates. We examined the impact of Social Deprivation Index (SDI) score, a proxy for area SES, and other socioeconomic demographics, on hospital arrival times of thrombectomy patients.
Methods: Data were retrospectively reviewed for large vessel occlusion acute ischemic stroke adults patients from 2019-2023 who were treated with thrombectomy at a single level 1 trauma center. Patients must have been from the field or presented to an outside hospital first for stroke before transfer; patients with in-hospital strokes were excluded. Prolonged arrival time was defined as more than 6 hours from the approximate last known well time. A multivariable logistic regression with 5-fold cross-validation was performed for prolonged arrival time with clinically or statistically significant covariables, with adjusted odds ratios (aOR) and 95% CI being reported.
Results: Of 429 patients included, thrombolytic agents were given to 45.3% of early arrivals and to only 3.0% of prolonged arrivals. In the multivariable regression, the two highest SDI quartiles (SDI 50 to <75, aOR: 2.12, 95% CI: 1.11-4.03, p=0.02; SDI 75 to 100, aOR: 2.75, 95% CI: 1.45-5.24, p=0.002) were independently associated with prolonged arrival time. Additionally, both Black (aOR: 2.33, 95% CI: 1.29-4.23, p=0.01) and Hispanic (aOR: 2.98, 95% CI: 1.24-7.13, p=0.01) patients were significantly associated with having prolonged arrival times. The multivariable logistic regression had AUC 0.70 (95% CI: 0.66-0.72), and cross-validation had AUC 0.68 (95% CI: 0.63-0.75).
Conclusion: Race and SDI are factors significantly associated with presentation time following ischemic stroke symptom onset and, subsequently may impact access to and efficacy of reperfusion therapy. Arrival times may be potentially used as a proxy for assessing efficacy of community-level interventions for mitigating disparities in access to stroke care and improving outcomes.