Key result
Hispanic ethnicity linked to ~36% higher acute reperfusion receipt vs White patients.
Why the study?
The associations between individual- and county-level social determinants of health and reperfusion therapies for acute ischemic stroke had been described separately, but rarely studied together.
Do individual- and county-level social determinants of health influence the receipt of acute reperfusion therapies in adults with acute ischemic stroke?
Cohort (n=1,520,627)
Yes
Do individual- and county-level social determinants of health influence the receipt of acute reperfusion therapies in adults with acute ischemic stroke?
Relative Risk: 1.36 (95% CI 1.33–1.4)
Individual and county-level social determinants of health, including race, rural residence, and education levels, independently influence the likelihood of receiving acute ischemic stroke reperfusion therapies, partly mediated by missing last known well times.
SDOH disparities in reperfusion access persist; leaves open whether targeted interventions can improve equity in stroke care.
BACKGROUND: The associations between individual- and county-level social determinants of health and reperfusion therapies (thrombolysis or thrombectomy) for acute ischemic stroke have been described separately, but they are rarely studied together. METHODS AND RESULTS: We identified 1.5 million patients aged ≥40 years with acute ischemic stroke between January 1, 2015 and December 31, 2019 from the Get With The Guidelines-Stroke registry in the United States. We ascertained age, sex, rural residence, and ethnicity or race at the individual level, and poverty, unemployment, and lower education (defined as less than high school) at the county level. We used multivariable log-binomial regression models estimated using generalized estimating equations methods to account for county-level clustering and adjusted for comorbidities. About 13.4% (n=203 800) patients received reperfusion therapy. Black (adjusted risk ratio [aRR, 1.06 [95% CI, 1.04-1.07]) and Hispanic (aRR, 1.36 [95% CI, 1.33-1.40]) patients were more likely to receive it compared with White patients, as were those in counties with lower education (aRR, 1.08 [95% CI, 1.07-1.09]). Older adults (5-year increase in age aRR, 97 [95% CI, 0.97-0.97]), rural residents (aRR, 0.58 [95% CI, 0.56-0.59]), and those with missing last known well time (aRR, 0.30 [95% CI, 0.29-0.30]) were less likely to receive it. Missing last known well was less likely in Hispanic (aRR, 0.94 [95% CI, 0.92-0.95]) and Asian (aRR, 0.93 [95% CI, 0.90-0.96]) patients compared with White patients and more likely in those residing in counties with high unemployment (aRR, 1.07 [95% CI, 1.06-1.08]). CONCLUSIONS: Individual- and county-level social determinants of health were associated with reperfusion therapies and missing last known well times. Understanding the mechanisms by which these factors could affect treatment eligibility through time-based criteria can help increase reperfusion therapies for all.
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Vyas et al. (2025) conducted a cohort in Acute ischemic stroke (n=1,520,627). Hispanic race/ethnicity vs. White race/ethnicity was evaluated on Receipt of hyperacute reperfusion therapy (thrombolysis, thrombectomy, or both) (aRR 1.36, 95% CI 1.33-1.40). Individual- and county-level social determinants of health significantly influenced treatment, with Hispanic patients being more likely to receive acute reperfusion therapies compared to White patients (aRR 1.36), while rural residents were substantially less likely.
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