Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index
Background Access to endovascular stroke centers (ESCs) is crucial for patients to receive optimal care for large‐vessel occlusion strokes. Disparities in stroke care are well documented, including differences in patients who receive intravenous thrombolysis and endovascular therapy. Here, we descri...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-05-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000684 |
| _version_ | 1797834890666835968 |
|---|---|
| author | Derek L. Isenberg Raluca Isenberg Kevin A. Henry Chadd K. Kraus Daniel Ackerman Adam Sigal Joseph Herres Ethan S. Brandler Alexander Kuc Jason T. Nomura Derek R. Cooney Nina T. Gentile |
| author_facet | Derek L. Isenberg Raluca Isenberg Kevin A. Henry Chadd K. Kraus Daniel Ackerman Adam Sigal Joseph Herres Ethan S. Brandler Alexander Kuc Jason T. Nomura Derek R. Cooney Nina T. Gentile |
| author_sort | Derek L. Isenberg |
| collection | DOAJ |
| description | Background Access to endovascular stroke centers (ESCs) is crucial for patients to receive optimal care for large‐vessel occlusion strokes. Disparities in stroke care are well documented, including differences in patients who receive intravenous thrombolysis and endovascular therapy. Here, we describe racial, ethnic, sex, and social disparities in access to ESCs using the Social Vulnerability Index (SVI), a composite measure of a community's health. Methods This is a population‐based study of 4 Northeastern states. We geocoded all ESCs in New York, New Jersey, Pennsylvania, and Delaware and calculated the distance from the centroid of each census tract to the nearest ESC. We then used the US Centers for Disease Control's Social Vulnerability Index and its 4 subcomponents to calculate the health of that census tract. Results are presented as mean drive times by quartile of SVI (quartile 1=least vulnerable, quartile 4=most vulnerable) and the mean SVI dichotomized to census tracts located less than and greater than 60 minutes to the nearest ESC. Results A total of 42 000 000 people and 10 000 census tracts were included in our data. There were no significant differences in the mean SVI for census with drive times of <60 minutes versus >60 minutes to the nearest ESC. However, there were significant differences in 2 subcomponents of the SVI: Minority Status & Language and Household Composition & Disability. In the Minority Status subcomponent of the SVI, those in the most vulnerable census tracts (quartile 4) were located closest to ESCs compared with the least vulnerable census tracts (quartile 1), while for the Household Composition subcomponent, the most vulnerable census tracts were located farthest from the ESCs. Conclusion The SVI is a valuable tool for assessing disparities in access to advanced stroke care and predicting where additional ESCs should be added to benefit the population as a whole. |
| first_indexed | 2024-04-09T14:45:48Z |
| format | Article |
| id | doaj.art-927fc24ddc574022ae969f764c70e411 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-09T14:45:48Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-927fc24ddc574022ae969f764c70e4112023-05-02T18:30:22ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-05-013310.1161/SVIN.122.000684Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability IndexDerek L. Isenberg0Raluca Isenberg1Kevin A. Henry2Chadd K. Kraus3Daniel Ackerman4Adam Sigal5Joseph Herres6Ethan S. Brandler7Alexander Kuc8Jason T. Nomura9Derek R. Cooney10Nina T. Gentile11Lewis Katz School of Medicine at Temple University Philadelphia PACooper University Hospital Camden NJTemple University Philadelphia PAGeisinger Danville PASt. Luke's Health System Bethlehem United States PAReading Hospital West Reading PAEinstein Health System Philadelphia PAState University of New York Stony Brook NYCooper University Hospital Camden NJChristiana Care Newark DEState University of New York‐Upstate Syracuse NYLewis Katz School of Medicine at Temple University Philadelphia PABackground Access to endovascular stroke centers (ESCs) is crucial for patients to receive optimal care for large‐vessel occlusion strokes. Disparities in stroke care are well documented, including differences in patients who receive intravenous thrombolysis and endovascular therapy. Here, we describe racial, ethnic, sex, and social disparities in access to ESCs using the Social Vulnerability Index (SVI), a composite measure of a community's health. Methods This is a population‐based study of 4 Northeastern states. We geocoded all ESCs in New York, New Jersey, Pennsylvania, and Delaware and calculated the distance from the centroid of each census tract to the nearest ESC. We then used the US Centers for Disease Control's Social Vulnerability Index and its 4 subcomponents to calculate the health of that census tract. Results are presented as mean drive times by quartile of SVI (quartile 1=least vulnerable, quartile 4=most vulnerable) and the mean SVI dichotomized to census tracts located less than and greater than 60 minutes to the nearest ESC. Results A total of 42 000 000 people and 10 000 census tracts were included in our data. There were no significant differences in the mean SVI for census with drive times of <60 minutes versus >60 minutes to the nearest ESC. However, there were significant differences in 2 subcomponents of the SVI: Minority Status & Language and Household Composition & Disability. In the Minority Status subcomponent of the SVI, those in the most vulnerable census tracts (quartile 4) were located closest to ESCs compared with the least vulnerable census tracts (quartile 1), while for the Household Composition subcomponent, the most vulnerable census tracts were located farthest from the ESCs. Conclusion The SVI is a valuable tool for assessing disparities in access to advanced stroke care and predicting where additional ESCs should be added to benefit the population as a whole.https://www.ahajournals.org/doi/10.1161/SVIN.122.000684endovascular stroke centershealth disparitiesischemic stroke |
| spellingShingle | Derek L. Isenberg Raluca Isenberg Kevin A. Henry Chadd K. Kraus Daniel Ackerman Adam Sigal Joseph Herres Ethan S. Brandler Alexander Kuc Jason T. Nomura Derek R. Cooney Nina T. Gentile Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index Stroke: Vascular and Interventional Neurology endovascular stroke centers health disparities ischemic stroke |
| title | Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index |
| title_full | Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index |
| title_fullStr | Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index |
| title_full_unstemmed | Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index |
| title_short | Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index |
| title_sort | assessing disparities in access to advanced stroke care in 4 northeastern states using the social vulnerability index |
| topic | endovascular stroke centers health disparities ischemic stroke |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000684 |
| work_keys_str_mv | AT dereklisenberg assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT ralucaisenberg assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT kevinahenry assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT chaddkkraus assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT danielackerman assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT adamsigal assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT josephherres assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT ethansbrandler assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT alexanderkuc assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT jasontnomura assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT derekrcooney assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex AT ninatgentile assessingdisparitiesinaccesstoadvancedstrokecarein4northeasternstatesusingthesocialvulnerabilityindex |