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Area of Science:

  • Neurology
  • Public Health
  • Health Services Research

Background:

  • Stroke care infrastructure has advanced, but equitable access to certified stroke centers in rural areas remains uncertain.
  • The impact of recent stroke center expansions on rural patients across different income levels is not well understood.

Purpose of the Study:

  • To assess if rural communities of varying incomes experienced similar gains in access to certified stroke centers.
  • To determine if stroke center expansions were associated with improved acute stroke treatment and outcomes in rural populations.

Main Methods:

  • Retrospective cohort study using Medicare data (2009-2019) of rural US residents with acute ischemic stroke.
  • Communities were classified as 'exposed' if a new certified stroke center opened within a 30-minute drive.
  • Evaluated changes in hospital admission, thrombolysis, thrombectomy, and one-year mortality using a fixed-effects linear probability model.

Main Results:

  • High-income rural communities were more likely to gain access to newly certified stroke centers, especially higher-tier Thrombectomy-Capable Stroke Centers (TSCs) or Comprehensive Stroke Centers (CSCs).
  • Exposure to certified stroke centers increased the likelihood of receiving thrombolysis and thrombectomy.
  • No significant differences in one-year mortality were observed between income groups.

Conclusions:

  • Rural stroke center expansion during 2009-2019 disproportionately benefited high-income communities.
  • These access disparities correlated with unequal improvements in advanced stroke treatments, potentially widening income-based disparities in rural stroke care.
  • Equity-focused strategies are needed to ensure infrastructure improvements yield equitable clinical benefits for all rural stroke patients.