Schieb Linda, Tootoo Joshua, Fiffer Melissa, Casper Michele, Zephyr Dominique Pierre, Bunney E Bradshaw, Miranda Marie Lynn
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Children's Environmental Health Initiative, University of Illinois Chicago.
Prev Chronic Dis. 2025 Jul 3;22:E33. doi: 10.5888/pcd22.240429.
Timely access to stroke care reduces death and disability due to stroke. Studies have investigated disparities in access by sociodemographic characteristics but not comorbidity prevalence. We used updated data to assess both types of disparities in drive times to certified stroke centers nationwide.
We conducted a cross-sectional spatial analysis of drive time from each contiguous US census tract (N = 72,517), using population-weighted centroids, to any certified stroke care (n = 1,825) or advanced (ie, endovascular-capable) stroke care (n = 426), using 2022 data from multiple state and nationwide databases. We compared median comorbidity prevalence and sociodemographic characteristics for census tracts within versus beyond a 60-minute drive time, using US Centers for Disease Control and Prevention PLACES 2020 data.
Median (interquartile range) drive time was 11.8 (7.6-21.6) minutes to any certified stroke care, and 23.0 (12.6-53.9) minutes to advanced stroke care. Approximately 20% of the US adult population (n = 49 million) resided in census tracts beyond a 60-minute drive from advanced stroke care; most (65%) were rural. Census tracts more than 60 minutes from advanced stroke care had significantly higher prevalence of stroke, high blood pressure, coronary heart disease, high cholesterol, diabetes, chronic kidney disease, fair or poor self-rated health status, smoking, and obesity. They also had higher poverty rates, lower educational attainment, lower median income, and higher proportions of non-Hispanic White people and people older than 65 years.
Residents in census tracts lacking timely access to stroke care have higher prevalence of health risk factors. The results highlight areas where education, telehealth infrastructure, and facility placement could improve stroke systems of care.
及时获得中风护理可降低中风导致的死亡和残疾风险。已有研究调查了社会人口统计学特征在获得护理方面的差异，但未涉及合并症患病率的差异。我们使用最新数据评估了全国范围内前往认证中风中心的驾车时间在这两类差异方面的情况。
我们进行了一项横断面空间分析，利用人口加权质心，计算美国每个相邻人口普查区（N = 72,517）到任何认证中风护理机构（n = 1,825）或高级（即具备血管内治疗能力）中风护理机构（n = 426）的驾车时间，数据来自多个州和全国性数据库的2022年数据。我们使用美国疾病控制与预防中心2020年的PLACES数据，比较了驾车时间在60分钟以内和以外的人口普查区的合并症患病率中位数以及社会人口统计学特征。
到任何认证中风护理机构的驾车时间中位数（四分位间距）为11.8（7.6 - 21.6）分钟，到高级中风护理机构的驾车时间为23.0（12.6 - 53.9）分钟。约20%的美国成年人口（n = 4900万）居住在距离高级中风护理机构驾车时间超过60分钟的人口普查区；其中大多数（65%）为农村地区。距离高级中风护理机构超过60分钟的人口普查区，中风、高血压、冠心病、高胆固醇、糖尿病、慢性肾病、自我评估健康状况为一般或较差、吸烟和肥胖的患病率显著更高。这些地区的贫困率也更高，教育程度更低，收入中位数更低，非西班牙裔白人以及65岁以上人群的比例更高。
无法及时获得中风护理的人口普查区居民，健康风险因素的患病率更高。研究结果突出了在教育、远程医疗基础设施和机构布局方面可改善中风护理系统的领域。
