Abstract Body: Introduction: While the implementation of Stroke Systems of Care (SSOC) policies have proven beneficial to the general population, their effectiveness among racial minorities and economically disadvantaged groups remains uncertain. This study investigates the effects of the Stroke Prevention and Treatment Act of 2009 in Rhode Island and subsequent changes in mortality rates across different racial and socioeconomic groups.

Methods: Publicly available data from the Rhode Island Department of Labor and Training, CDC Atlas of Heart Disease and Stroke, and US Census Bureau for the years 2005-2014 informed the study. Multivariate regression was employed to analyze the relationship between county-level racial demographics and mortality rates from ischemic, hemorrhagic, and all stroke. A difference-in-difference analysis compared stroke mortality rates among White, Black, and Hispanic residents before and after the Act’s passage. Trends identified in these analyses were further validated using a mixed-effects model.

Results: After SSOC policy implementation, the overall population demonstrated significant decline in ischemic (-13.6%; P<0.001), hemorrhagic (-5.5%; P=0.011), and all strokes (-12.9%; P<0.001). White residents showed significant reductions in ischemic (15.0%; P<0.001), hemorrhagic (-5.0%; P=0.021), and all stroke (-13.6%; P<0.001) mortality. However, Black residents showed an insignificant drop in hemorrhagic stroke mortality (-13.1%; P=0.235), with insignificant increases in ischemic (11.6%; P=0.877) and all stroke (12.8%; P=0.187) mortality. Hispanic residents experienced a significant decrease in overall stroke mortality (-12.1%; P=0.003), though reductions in ischemic (-9.1%; P=0.058) and hemorrhagic (-21.7%; P=0.064) stroke mortality were not statistically significant. There were insignificant changes in total (P=0.997), White (P=0.740), Black (P=0.667), and Hispanic (P=0.903) populations before and after policy implementation.

Conclusion: SSOC policies significantly reduced stroke mortality among the general population and White residents in Rhode Island, but these benefits did not extend equally to Black and Hispanic groups. This disparity highlights the need for future stroke legislation to consider social determinants of health and the unique barriers faced by minority populations to enhance overall care.