Areas with a high incidence of delay in hospital arrival after ischemic stroke are characterized by increased social vulnerability, according to a study published online May 24 in Stroke.

Amar Dhand, M.D., D.Phil., from Brigham and Women’s Hospital in Boston, and colleagues created a geospatial map of prehospital delay and examined the role of community-level social vulnerability in patients with ischemic stroke. The time to hospital arrival after stroke (in minutes) was examined as the primary outcome, in most cases beginning from last known well. The geography of delay was displayed using Geographic Information System mapping. The relationship between community-level factors and arrival time was assessed using Cox proportional hazards models.

Overall, 149,145 patients met the inclusion criteria. The researchers found that the median time to hospital arrival was 140 minutes. Many zones of delay overlapped with socially vulnerable areas based on the geospatial map. Cox models confirmed the association for higher social vulnerability index (SVI), including quartiles 3 and 4, with delay (adjusted hazard ratios [aHRs], 0.96 and 0.93, respectively). Compared with patients from SVI quartile 1, patients from SVI quartile 4 neighborhoods arrived 15.6 minutes slower. A community’s socioeconomic status (aHR, 0.80) and housing type and transportation (aHR, 0.89) were SVI themes associated with delay.

“We are hopeful that this practical and objective tool can be the first guide in supporting nationwide efforts to understand the underpinnings of delays in stroke care and plan neighborhood-by-neighborhood stroke preparedness campaigns,” Dhand said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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