Abstract

Socioeconomic status (SES) significantly impacts healthcare access and outcomes in acute stroke management. Patients from lower SES backgrounds may face delays in emergency medical services (EMS) utilization, reduced access to time-sensitive treatments such as tenecteplase (TNK) and mechanical thrombectomy, and lower rates of post-hospitalization follow-up. This study investigates the disparities in stroke care based on SES by comparing mode of transportation, treatment rates, arrival times, and clinical outcomes. 

Methods: 

This retrospective cohort study analyzed ischemic stroke patients treated between 2023-2024 at a comprehensive stroke care center. SES classification was based on average income by zip code, insurance status, employment, and residence type. Key variables included mode of transportation (EMS vs. private transport), last known normal (LNK) to emergency department (ED) arrival time, TNK and thrombectomy utilization, discharge outcomes, and follow-up rates. Statistical analyses included univariate and multivariable comparisons between low and high SES groups.

Preliminary Results:

• Mode of Transportation: Low SES patients were less likely to arrive via EMS (84.9% vs. 94.4%) and were more likely to use private transport (13.2% vs. 5.6%).
• LNK to ED Arrival: Low SES patients had a longer mean LNK-to-arrival time (1596 min vs. 1092 min), suggesting delayed presentation.
• Treatment Disparities: Low SES patients were slightly more likely to receive TNK (45.3% vs. 41.7%) but were less likely to undergo thrombectomy (26.4% vs. 44.4%).
• Clinical Outcomes: Low SES patients had a higher rate of unfavorable modified Rankin Scale (mRS) scores at discharge (52.8% vs. 66.7%) and lower rates of favorable outcomes at 90 days (3.8% vs. 2.8%).
• Follow-Up and Mortality: Low SES patients were more likely to miss follow-ups (69.8% vs. 63.9%) and had a higher mortality rate (13.2% vs. 8.3%).

Conclusion:

Patients from lower SES backgrounds experience significant delays in acute stroke presentation, are less likely to receive thrombectomy, and exhibit poorer follow-up adherence and higher mortality rates. These disparities underscore the need for targeted interventions, including improved EMS accessibility, streamlined acute stroke protocols for disadvantaged populations, and enhanced post-discharge support systems to bridge the care gap.