Breaking Paradigms: Mexico's Stroke Roadmap Assessing Institutional Resources Using World Stroke Organization...

Area of Science:

• Public Health
• Neurology
• Health Services Research

Background:

• Assesses geographic distribution and accessibility of stroke care resources in Mexico's public health system.
• Highlights disparities in access, particularly in remote and underserved areas.
• Defines Essential Stroke Centers (ESCs) and Advanced Stroke Centers (ASCs) based on World Stroke Organization (WSO) criteria.

Purpose of the Study:

• To evaluate institutional resources for acute stroke care across public hospitals in Mexico.
• To identify disparities in access to stroke care, especially advanced treatments like thrombectomy.
• To map the accessibility of stroke centers based on travel time.

Main Methods:

• Cross-sectional study using a validated online survey distributed to public hospitals (IMSS, ISSSTE, IMSS-Bienestar, PEMEX, SEMAR).
• Hospitals georeferenced and classified as ESCs or ASCs per WSO Roadmap criteria.
• Isochrones generated using road network data to determine travel times to stroke centers.

Main Results:

• 85% of at-risk individuals are within 60 minutes of an Essential Stroke Center (ESC).
• 14% of individuals aged ≥40 years (over 6.3 million) are more than 60 minutes from the nearest ESC.
• Over half of the population aged ≥40 years is more than an hour from an Advanced Stroke Center (ASC), indicating "stroke care deserts" for thrombectomy.

Conclusions:

• Significant infrastructural and logistical barriers hinder equitable access to life-saving endovascular therapies.
• Interinstitutional collaboration, standardized protocols, and optimized referral networks are crucial for universal stroke care.
• Addressing these gaps is essential to reduce mortality and disability in Mexico's public health system.