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Abstract Background Globally, stroke is a leading cause of mortality and disability, affecting approximately 15 million people annually. This study aimed to analyze hospitalizations, deaths, and thrombolysis for ischemic stroke in Southern Brazil, evaluate access within the 4.5-hour window at Neurological Reference Centers (NRCs), and explored potential coverage expansions. Methods An ecological study was conducted using hospitalization data, intravenous thrombolysis administration, and ischemic stroke related deaths among individuals aged 40–79 years treated in the Brazilian Unified Health System and residing in the Southern region between 2015 and 2024. Space Cube Time analyses, the Enhanced Two-Step Floating Catchment Area method, and spatial coverage simulations for potential new centers using the Maximal Covering Location Problem model were applied. Results The Space-Time Cube analysis revealed no significant temporal trends in hospitalization and mortality rates due to ischemic stroke (Mann–Kendall test, p = 1.000), while a statistically significant increasing trend was observed in the use of thrombolytic therapy (trend = 3.0411; p = 0.0024), despite only 5% of hospitalized patients receiving the treatment. Furthermore, greater distance and travel time to NRCs were associated with higher mortality rates: municipalities located within two hours of an NRC showed a lower mean mortality rate (14.88 per 100,000 inhabitants) compared with those beyond this range (17.35 per 100,000 inhabitants), representing a difference of 2.47 deaths per 100,000 inhabitants (p < 0.005). Given this disparity, the simulation of adding 10 new NRCs, in addition to the 49 existing ones, estimated the prevention of 21.45 deaths per year, totaling approximately 214 deaths avoided over a decade. Conclusion The combined findings of low intravenous thrombolysis utilization, limited access to NRCs, and higher mortality rates in inland municipalities underscore the need to expand specialized stroke care. Moreover, the simulation results indicate that broadening the coverage of NRCs could inform health policy planning aimed at reducing inequities in stroke care and lowering mortality and morbidity.
Bonfim et al. (Mon,) studied this question.