Abstract Body: Background
Disparities in stroke care and outcomes based on socioeconomic status (SES) are well documented yet remain under-examined in large, diverse populations. This study investigates the relationships between SES, care quality, and clinical outcomes in patients hospitalized with acute ischemic stroke.

Objective
Utilizing data from Get With The Guidelines®-Stroke, this study aims to show how socioeconomic determinants are associated with stroke care and outcomes.

Methods
We conducted a cohort study using GWTG Stroke registry data from January 1, 2010 to December 31, 2019 linked with Institute of Health Metrics and Evaluation (IHME) socioeconomic indicators. Patients were stratified into quartiles based on county-level socio-economic status using the social vulnerability index (SVI). We evaluated baseline patient traits, hospital traits, variability of guideline recommended treatments (e.g. deep vein thrombosis (DVT) prophylaxis, antithrombotic therapy), and clinical outcomes, including: in-hospital mortality, discharge status, ambulatory status, and length of hospital stay. Generalized estimating equations accounting for within-hospital clustering were used to assess the relationships between socioeconomic status and outcomes adjusting for potential confounders (i.e., age, sex, prior medical history and stroke severity at presentation).

Results
The analysis included 1,394,981 patients with acute ischemic stroke. The median age was 71 years, 49.8% were female, and 17.1% were Black. Significant differences were observed across SES quartiles (Group 1 highest SES) in demographics, arrival status, and hospital traits. Compared to lowest SES, being in the highest SES group (i.e., lowest vulnerability) was associated with increased timeliness for tPA administration (OR 1.13, 95% CI 1.00-1.27), higher receipt of DVT prophylaxis (OR 1.41, 95% 1.17-1.70), increased prescription of antithrombotic therapy at discharge (OR 1.28, 95% CI 1.06-1.56), reduced risk of mortality or discharge to hospice (OR 0.88, 95% CI 0.79-0.97), and a prolonged hospital stay (OR 0.80, 95% CI 0.89-0.89).

Conclusions
This study highlights that socioeconomic status is associated with significant disparities in stroke care and outcomes, suggesting the need for targeted strategies to ensure equitable care across all socioeconomic groups. Policymakers and healthcare providers must address these disparities to improve outcomes for all patients with acute ischemic stroke.