{
  "abstract": "Introduction/Purpose Stroke care in the United States has expanded substantially over the past century, however disparities in access to advanced care persist and are poorly characterized. Our study evaluates the population-level relationship between stroke burden and stroke care capacity in every state and county across the nation.Materials and Methods We conducted a retrospective, cross-sectional analysis of stroke care access across 3,204 U.S. county-equivalent jurisdictions. Using public data from the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the U.S. Census Bureau, and national stroke certification bodies, we developed a Stroke Care Access Index (SCAI) integrating county-level stroke burden with hospital capability and capacity. Using SCAI percentile stratification, we created a choropleth visualization representing stroke care access in every U.S. county, viewable at https://stroke-insights.streamlit.app/. This application will automatically integrate updated datasets every year to depict live changes in stroke care access and highlight areas in need of improvement.Results Lower-populated counties were disproportionately served by lower-capability stroke centers (acute stroke ready hospitals and primary stroke centers), with significant underrepresentation of thrombectomy-capable and comprehensive stroke centers. Primary stroke centers were overrepresented across most county population strata, while advanced centers clustered significantly in wealthier and higher-populated counties. Results were similar between medically underserved and non-medically underserved counties, suggesting that gaps in advanced stroke care reflect a broader nationwide imbalance rather than disparities limited to underserved regions. In our choropleth map, the Northeast and Upper Midwest regions demonstrated the best county and state SCAI scores, whereas the South Central and Southeastern regions exhibited the lowest, particularly in stroke belt areas.Conclusion Despite efforts to improve stroke systems of care, access to advanced care remains uneven and associated with population density, socioeconomic status, and geographic region. Our results suggest that infrastructure development should be prioritized in regions with high stroke burden and limited access to advanced therapies, particularly rural areas and regions within the stroke belt. The SCAI provides a scalable tool for identifying gaps in stroke care and may help inform regional stroke system planning.Disclosures S. Shah: None. E. Singh: None. A. Kabir: None. J. Bernabei: None. V. Letchuman: None.Abstract E-166 Table 1States with the highest population-weighted mean stroke care access index1Massachusetts0.842New York0.803New Hampshire0.744Vermont0.745Illinois0.736New Jersey0.707Minnesota0.708Rhode Island0.699California0.6810Iowa0.67Abstract E-166 Table 3Stroke center distribution by county population size and medically underserved area statusCategory TypeCategoryN CentersAcute Stroke Ready HospitalPrimary Stroke CenterThrombectomy-Capable Stroke CenterComprehensive Stroke CenterCounty SizeNoncore (<10,000)239 (39.1%)10 (43.5%)0 (0.0%)†4 (17.4%)Micropolitan (10,000-49,000)16393 (57.0%)*67 (41.1%)*1 (0.6%)†2 (1.2%)†Small metro (50,000-249,000)53566 (12.3%)†415 (77.6%)*11 (2.1%)†43 (8.0%)†Medium metro (250,000-999,999)73537 (5.3%)†466 (63.4%)*42 (5.7%)†190 (25.9%)Large metro (>1,000,000)52111(2.1%)†318 (61.0%)*41 (7.9%)†151 (29.0%)Medically Underserved Area StatusMedically Underserved Area1790179 (10.0%)†1147 (64.1%)*90 (5.0%)†374 (20.9%)†Non-Medically Underserved Area17633 (18.8%)124 (70.5%)*5 (2.8%)†14 (8.0%)†Abstract E-166 Table 2States with the lowest population-weighted mean stroke care access index41Alaska0.4442Arizona0.4443New Mexico0.4444Arkansas0.4245Tennessee0.4146Louisiana0.4147Nevada0.3748Mississippi0.3649Oklahoma0.3550Texas0.28",
  "authors": [
    {
      "affiliations": [
        "Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "S Shah"
    },
    {
      "affiliations": [
        "University of California, Los Angeles, Los Angeles, CA"
      ],
      "name": "E Singh"
    },
    {
      "affiliations": [
        "School of Medicine, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "A Kabir"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "J Bernabei"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "V Letchuman"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA"
      ],
      "name": "D Raper"
    }
  ],
  "title": "E-166 Stroke care access in the united states: a geospatial and population-based evaluation",
  "uid": "01b8d508-7c49-5efe-a229-961a5aecfc56"
}