Neighborhood-level variation in prehospital care of patients with suspected stroke in Rhode Island

Abstract

Objective: This study aims to identify neighborhood-level inequities in prehospital stroke care, including EMS utilization and last known well (LKW) to ED presentation, in a small state with one large comprehensive stroke center.

Methods: This was a retrospective observational study using 2 years of data (2020-2022) from Get With The Guidelines combined with data collected by a large hospital system in Rhode Island that includes a comprehensive stroke center (CSC), the Rhode Island emergency management system database, and 2020 census data.

Results: Census tract disadvantage was significantly associated with LKW to ED arrival times, with individuals from more disadvantaged neighborhoods presenting almost a full hour later than individuals from the least disadvantaged neighborhoods (56.9 min, 95% confidence interval 14.9-90.3 min). EMS use was the strongest predictor of LKW to ED arrival times, and the Latinx population was significantly less likely to utilize EMS compared to the White population.

Conclusions: Understanding geographical inequities in stroke recognition and prehospital stroke care can help mitigate important socioeconomic and racial/ethnic disparities. In addition, geospatial analysis provides useful information for targeting intervention strategies to neighborhoods with the longest LKW to ED arrival times and lowest use of EMS.