Introduction:
To establish a statewide stroke system in March 2019, New York State (NYS) created the Stroke Designation Program. Stroke centers (SCs) must be certified by a state-approved certifying organization (CO), which is tasked with initial designation and ongoing re-certification. Previous research has found an association at the national level between socioeconomic status and access to higher levels of acute stroke care.
Objective:
This study characterizes the relationship between socioeconomic status of NYS populations and stroke care level access by comparing median household income and wealth in counties with and without certified SCs.
Methods:
Population and median household income from the U.S. Census (2010), stroke epidemiological data from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within NYS) from the Neighborhood Atlas, a project that quantifies disadvantage by census tract, were collected and averaged for each county. Income has been used to assess local wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs. Student’s t-tests compared income and ADI in counties with at least one certified SC to those without. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality.
Results:
All 62 counties in NYS were investigated to yield 40 certified SCs. Counties with at least one certified SC had a significantly higher income ($68,183.63 vs. $57,155.12; p=0.03) and lower ADI (5.90 vs. 7.37; p=0.004) compared to counties with no certified SC. Higher income (p<0.001) and lower ADI (p<0.001) were also associated with more certified SCs. Counties with fewer certified SCs had significantly higher stroke mortality (p<0.001) despite having similar stroke incidence.
Conclusion:
Socioeconomic heterogeneity in NYS counties is correlated to differential access to certified SCs and quality stroke care, as fewer centers are found in lower-income and disadvantaged communities. Although populations with less access experience stroke at similar rates, this study finds higher death rates in these counties.
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