Abstract TP029: Association Between Social Drivers of Health and Intravenous Thrombolytic Administration for the Treatment of Acute Ischemic Stroke

Background: Social drivers of health (SDOH) such as race, ethnicity, income, and insurance are significantly associated with worse stroke-related outcomes. This disparity has previously been attributed to inequities in post-stroke rehabilitation; however, another factor may be the influence of SDOH on treatment of acute ischemic stroke (AIS) with intravenous (IV) thrombolytic. To date, literature examining this interplay is limited. Thus, we investigated the association between SDOH variables and administration of IV thrombolytic among patients with AIS admitted to University of Virginia Medical Center. Methods: This was a retrospective, single-site cohort study of adult patients admitted 5/1/2018 - 5/31/2024 with a diagnosis of AIS based on primary ICD-10 code. Data were collected using the Get With The Guidelines® - Stroke registry and the electronic health record. Patient demographics and SDOH variables were compared using Pearson’s Chi-square and independent t-test. Binomial logistic regressions were used to evaluate the association between SDOH and receipt of IV thrombolytic, and between SDOH and arrival within treatment window (4.5 hours from last known well), with both models adjusted for age, sex, initial NIHSS, and comorbidities. Results: Among 2333 patients included, 314 (14%) received IV thrombolytic. Insurance status and rural-urban commuting area code (RUCA) category were independently predictive of receipt of IV thrombolytic (Uninsured OR 2.046, 95% CI 1.082 – 3.732; Micropolitan OR 0.583, 95% CI 0.355-0.908). When adjusted for confounders, insurance status remained significant with uninsured patients being more likely to receive thrombolytic compared to commercial insurance (OR 3.821, 95% CI 1.541-10.140 ( Figure 1A ). Patients living in micropolitan and rural areas were less likely to arrive at the hospital within the treatment window compared to those living in metropolitan areas ( Figure 1C ), and patients with Medicaid and Medicare were less likely to arrive within window compared to those with commercial insurance ( Figure 1D ). Conclusion: The results of this study suggest that some SDOH, particularly insurance and locality, are significantly associated with the administration of IV thrombolytic and arrival within window at our institution. These findings highlight the complex relationship between SDOH and AIS treatment. Further investigation is needed to better understand these associations and to ensure equitable access to acute stroke care.