Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index

Derek L. Isenberg; R Isenberg; KA Henry; Chadd K. Kraus; Daniel Ackerman; Adam Sigal; Joseph Herres; Ethan S. Brandler; Alexander Kuc; Jason T. Nomura; DR Cooney; Nina T. Gentile

doi:10.1161/SVIN.122.000684

Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index

Derek L. Isenberg
, R Isenberg
, KA Henry
, Chadd K. Kraus
, Daniel Ackerman
, Adam Sigal
, Joseph Herres
, Ethan S. Brandler
, Alexander Kuc
, Jason T. Nomura
, DR Cooney
, Nina T. Gentile

Cancer Prevention and Control (CPC)

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	American English
Article number	e000684
Pages (from-to)	e000684
Number of pages	8
Journal	Stroke-vascular and Interventional Neurology
Volume	3
Issue number	3
DOIs	https://doi.org/10.1161/SVIN.122.000684
State	Published - May 2023

Keywords

Endovascular stroke centers
Health disparities
Ischemic stroke

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10.1161/SVIN.122.000684

Cite this

Isenberg, D. L., Isenberg, R., Henry, KA., Kraus, C. K., Ackerman, D., Sigal, A., Herres, J., Brandler, E. S., Kuc, A., Nomura, J. T., Cooney, DR., & Gentile, N. T. (2023). Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index. Stroke-vascular and Interventional Neurology, 3(3), e000684. Article e000684. https://doi.org/10.1161/SVIN.122.000684

@article{79ed2654e70d41c887e87fc267d6c9e8,

title = "Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index",

abstract = "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.",

keywords = "Endovascular stroke centers, Health disparities, Ischemic stroke",

author = "Isenberg, \{Derek L.\} and R Isenberg and KA Henry and Kraus, \{Chadd K.\} and Daniel Ackerman and Adam Sigal and Joseph Herres and Brandler, \{Ethan S.\} and Alexander Kuc and Nomura, \{Jason T.\} and DR Cooney and Gentile, \{Nina T.\}",

note = "{\textcopyright} 2023 The Authors. Published on behalf of the American Heart Association, Inc., and the Society of Vascular and Interventional Neurology by Wiley Periodicals LLC.",

year = "2023",

month = may,

doi = "10.1161/SVIN.122.000684",

language = "American English",

volume = "3",

pages = "e000684",

journal = "Stroke-vascular and Interventional Neurology",

issn = "2694-5746",

number = "3",

}

Isenberg, DL, Isenberg, R, Henry, KA, Kraus, CK, Ackerman, D, Sigal, A, Herres, J, Brandler, ES, Kuc, A, Nomura, JT, Cooney, DR & Gentile, NT 2023, 'Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index', Stroke-vascular and Interventional Neurology, vol. 3, no. 3, e000684, pp. e000684. https://doi.org/10.1161/SVIN.122.000684

TY - JOUR

T1 - Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index

AU - Isenberg, Derek L.

AU - Isenberg, R

AU - Henry, KA

AU - Kraus, Chadd K.

AU - Ackerman, Daniel

AU - Sigal, Adam

AU - Herres, Joseph

AU - Brandler, Ethan S.

AU - Kuc, Alexander

AU - Nomura, Jason T.

AU - Cooney, DR

AU - Gentile, Nina T.

PY - 2023/5

Y1 - 2023/5

N2 - 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.

AB - 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.

KW - Endovascular stroke centers

KW - Health disparities

KW - Ischemic stroke

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Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index

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