Abstract 87: Eighteen-Year Trends in Ischemic Stroke Rates in a Bi-Ethnic Population

Introduction: Elevated stroke rates in Mexican Americans (MA) compared with non-Hispanic whites (NHW) persisted over the first decade of the 21 st century. Our objective was to investigate recent trends in ischemic stroke (IS) rates by ethnicity and age using data from a longstanding population-based study. Methods: ISs were identified in the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2000-2017) and validated by neurologists using a clinical definition. Race-ethnicity was from medical records. Annual population counts from the US Census estimated the at-risk population. Poisson regression was used to model sex-adjusted rate trends by ethnicity and age. Time was modeled using linear and quadratic terms. Ethnic differences were assessed using interaction terms between ethnicity and time. Results: 4,883 ISs were identified (median age 70 (IQR:59-80); 56% MA). Trends varied by ethnicity and age (figure). In those 45-59, rates increased substantially in NHWs (104%; p<0.001 for rate difference 2000-2017) but decreased in MAs (-21.4%; p=0.04 for rate difference 2000-2017) such that, for the first time, rates were higher in NHWs. In those 60-74, rates declined in both ethnic groups through 2010-2011 but then increased and more steeply in NHWs thereafter. In those ≥75, rates declined in MAs, declined sharply in NHWs through 2012 and then increased. Conclusions: New patterns in stroke have emerged. Ethnic disparities have declined as a result of increasing rates in NHWs most notably in midlife. Reasons for increasing rates in recent years are unclear but suggest renewed attention to prevention.

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Abstract T P132: Rapid loss of the Mexican American Survival Advantage After Stroke--The BASIC Study

Stroke ◽

10.1161/str.45.suppl_1.tp132 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Brisa N Sánchez ◽

Melinda Smith ◽

Devin Brown ◽

Nelda Garcia ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethnic Differences ◽

Mexican Americans ◽

Mexican American ◽

Population Based ◽

Survival Advantage ◽

Stroke Severity ◽

Basic Study ◽

Entire Study ◽

Corpus Christi

Background/Objective: As a primary, pre-specified objective of the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project we studied trends in mortality following ischemic stroke among Mexican Americans (MAs) and non Hispanic whites (NHWs). MAs were previously found to have lower mortality following stroke than NHWs. Methods: We performed active and passive surveillance, and using source documentation, validated all ischemic stroke cases from January, 2000-December, 2010. Deaths were ascertained from the Texas Department of Health through December 31, 2011. Cumulative 30 day and 1 year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Pre-specified adjustment factors were: age, sex, prior stroke or TIA, atrial fibrillation, diabetes, heart disease, hypertension, smoking, high cholesterol and stroke severity. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2010, and to calculate projected ethnic differences. Results: There were 1,822 ischemic strokes among NHWs and 2,211 among MAs. Between 2000 and 2010, 30 day and 1 year mortality declined among NHWs, from 8.6% to 5.9% (p=0.14), and 21.7% to 17.0% (p=0.06), respectively. Among MAs, 30 day mortality remained stagnant at 5.6% (p=0.98), and a slight decline from 18.3% to 16.4% was observed for 1 year mortality (p=0.41). While, the ethnic differences in 30 day (p=0.01) and 1 year (p=0.07) mortality were robust in 2000, they were not so in 2010 (30 day, p=0.76; 1 year p=0.78). See figure. MAs are projected to have higher post-stroke mortality by 2022. Conclusions: Overall, mortality following ischemic stroke has declined in the last decade. However, the survival advantage previously documented among MAs vanished by 2010. Further, faster declines in mortality among NHWs than MAs imply a reversal of the survival advantage by approximately 2022.

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Temporal Trends in Ischemic Stroke Rates by Ethnicity, Sex, and Age 2000–2017: The Brain Attack Surveillance in Corpus Christi Project

Neurology ◽

10.1212/wnl.0000000000012877 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012877

Author(s):

Lynda D. Lisabeth ◽

Devin L. Brown ◽

Darin B. Zahuranec ◽

Sehee Kim ◽

Jaewon Lim ◽

...

Keyword(s):

Ischemic Stroke ◽

Mexican Americans ◽

Temporal Trends ◽

Age Groups ◽

Population Based ◽

Relative Increase ◽

Stroke Incidence ◽

Corpus Christi ◽

Time Interaction ◽

Diagnosis Codes

Objective:To compare 18-year (2000-2017) temporal trends in ischemic stroke rates by ethnicity, sex and age.Methods:Data are from a population-based stroke surveillance study conducted in Nueces County, Texas, USA, a geographically isolated, bi-ethnic, urban community. Active (screening hospital admission logs, hospital wards, intensive care units) and passive (screening inpatient/ED discharge diagnosis codes) surveillance were used to identify cases aged ≥45 (n=4,874) validated by stroke physicians using a consistent stroke definition over time. Ischemic stroke rates were derived from Poisson regression using annual population counts from US Census to estimate at-risk population.Results:In those aged 45-59, rates increased in non-Hispanic Whites (104.3% relative increase; p<0.001) but decreased in Mexican Americans (-21.9%; p=0.03) such that rates were significantly higher in non-Hispanic Whites in 2016-2017 (p for ethnicity-time interaction<0.001). In those age 60-74, rates declined in both groups but more so in Mexican Americans (non-Hispanic Whites -18.2%, p=0.05; Mexican Americans -40.1%, p=0.002) resulting in similar rates for the two groups in 2016-2017 (p for ethnicity-time interaction=0.06). In those aged ≥75, trends did not vary by ethnicity, with declines noted in both groups (non-Hispanic Whites -33.7%, p=0.002; Mexican Americans -26.9%, p=0.02). Decreases in rates were observed in men (age 60-74 -25.7%, p=0.009; age ≥75 -39.2% p=0.002) and women (age 60-74 -34.3%, p=0.007; age ≥75 -24.0% p=0.02) in the two older age groups, while rates did not change in either sex in those age 45-59.Interpretation:Previously documented ethnic stroke incidence disparities have ended as a result of declining rates in Mexican Americans and increasing rates in non-Hispanic whites, most notably in midlife.

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Poststroke Cognitive Outcomes: Sex Differences and Contributing Factors

Journal of the American Heart Association ◽

10.1161/jaha.120.016683 ◽

2020 ◽

Vol 9 (14) ◽

Author(s):

Liming Dong ◽

Emily Briceno ◽

Lewis B. Morgenstern ◽

Lynda D. Lisabeth

Keyword(s):

Sex Differences ◽

Mexican Americans ◽

Population Based ◽

South Texas ◽

Cognitive Outcomes ◽

Tobit Regression ◽

Contributing Factors ◽

Care Needs ◽

Corpus Christi ◽

Using Data

Background The study investigated sex differences in cognitive outcomes at 90 days after first‐ever stroke using data from a population‐based sample. Methods and Results The study sample consisted of 1227 participants from the 2009–2016 Brain Attack Surveillance in Corpus Christi project (south Texas, United States) who had first‐ever ischemic stroke or intracerebral hemorrhage and survived 90 days after stroke. Poststroke cognitive function was assessed by the Modified Mini‐Mental State Examination (3MSE) (range: 0–100; dementia: <78). The associations of sex with dichotomized and continuous outcomes were examined using logistic regression and tobit regression, respectively. Inverse probability weighting and multiple imputation were used to deal with missing data. The study sample was evenly distributed by sex, and primarily composed of Mexican Americans (59.1%) and non‐Hispanic whites (34.1%). Women scored 2.96 points worse on the 3MSE than men at 90 days poststroke (95% CI, −3.99 to −1.93). The prevalence of dementia was 27.6% for men (95% CI, 23.5%–31.6%) and 35.6% for women (95% CI, 31.5%–39.7%), and the unadjusted odds ratio (OR) of dementia comparing women with men was 1.45 (95% CI, 1.24–1.69). The association was attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics (OR, 0.82; 95% CI, 0.61–1.09). Conclusions Women had worse cognitive outcomes than men at 90 days poststroke. The differences were attributable to sociodemographic and prestroke characteristics, especially widowhood status. Potential mechanisms linking widowhood to dementia in the acute poststroke stage warrant further investigation to inform interventions addressing the unique care needs of women stroke survivors with dementia and cognitive dysfunction.

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Abstract P625: Rate of Hemorrhagic Transformation After Ischemic Stroke and Associated Risk Factors: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Stroke ◽

10.1161/str.52.suppl_1.p625 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Robert J Stanton ◽

Eleni Antzoulatos ◽

Elisheva R Coleman ◽

Felipe De Los Rios La Rosa ◽

Stacie L Demel ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Case Fatality ◽

Population Based ◽

Hemorrhagic Transformation ◽

Incidence Rates ◽

Icd 10 ◽

Potential Risk Factors ◽

Adjusted Rate ◽

Associated Risk Factors

Background: Hemorrhagic transformation (HT) of ischemic stroke can have devastating consequences, leading to longer hospitalizations, increased morbidity and mortality. We sought to identify the rate of HT in stroke patients not treated with tPA within a large, biracial population. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2015, we captured all hospitalized strokes by screening ICD-9 codes 430-436 and ICD-10 codes I60-I68, and G45-46. Study nurses abstracted all potential cases and physicians adjudicated cases, including classifying the degree of HT. Patients treated with thrombolytics were excluded. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for HT cases, age and sex adjusted to the 2000 US population. Multiple logistic regression was used to examine risk factors associated with HT. Results: In 2015, there were 2301 ischemic strokes included in the analysis. Of these 104 (4.5%) had HT; 23 (22.1%) symptomatic, 55 (52.9%) asymptomatic and 26 (25%) unknown. Documented reasons for not receiving tPA in these patients were: time (71, 68.3%), anticoagulant use (1, 1.0%), other (18,17.3%) and unknown (14, 13.5%), which were not significantly different compared to those without HT. Only 29/104 (18.3%) had HT classified as PH-1 or PH-2. The age, sex and race-adjusted rate of HT was 9.8 (7.9, 11.6) per 100,000. The table shows rates of potential risk factors and the adjusted odds of developing HT. 90 day all-cause case fatality for patients with HT was significantly higher, 27.9% vs. 15.7%, p<0.0001. Conclusion: We found that 4.5% of non-tPA treated IS patients had HT. These patients had more severe strokes, were more likely to have abnormal coagulation tests or anticoagulant use, and were more likely to die within 90 days. We also report the first population-based incidence rate of HT in non-tPA treated of 9.8/100,000, a rate similar to the incidence of SAH.

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Abstract WP165: Mexican Americans Receive Less Intensive Stroke Rehabilitation Than non Hispanic Whites

Stroke ◽

10.1161/str.48.suppl_1.wp165 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Emma Sais ◽

Michael Fuentes ◽

Nneka Ifejika ◽

Xiaqing Jiang ◽

...

Keyword(s):

Mexican Americans ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

Population Based ◽

Cognitive Outcomes ◽

Rehabilitation Services ◽

Population Based Study ◽

Corpus Christi ◽

Home Based ◽

Chi Squared

Background: Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke than non Hispanic whites (NHWs). Stroke rehabilitation is important for outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods: Consecutive stroke patients were identified for a three month time period as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine self-reported rehabilitation services. Descriptive statistics were used to describe the study population. Ethnic comparisons of rehabilitation services were made using chi-squared or Fisher’s exact tests. Results: Seventy-two subjects (50 MA, 22 NHW) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS (NHW-2.5, MA-3.0) did not differ significantly. There were no ethnic differences in the proportion of patients who were discharged home without rehabilitation services (p=0.9). Among those who received rehabilitation (n=48), the figure shows the distribution of the first place for services. NHWs were more likely to be discharged to inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to be receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions: In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

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Abstract TP182: Stroke Outcome in Mexican American Immigrants and Non-Immigrants

Stroke ◽

10.1161/str.51.suppl_1.tp182 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Lynda Lisabeth ◽

River Gibbs ◽

Sehee Kim ◽

Charles Agyemang

Keyword(s):

Mexican Americans ◽

Mexican American ◽

Population Based ◽

Cognitive Outcome ◽

Stroke Outcome ◽

Linear Regression Models ◽

Corpus Christi ◽

Project Outcomes ◽

Stroke Study ◽

The U.S

Background/Objective: We studied the association of being born outside of the U.S. (immigrant) or born in the U.S. (non-immigrant) with 90 day post-stroke outcomes in a population-based stroke study in Texas. Methods: Stroke cases from 2008-2016 were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Outcomes among survivors included ADL/IADL score (higher scores worse) for functional assessment, 3MSE (cognition, lower scores worse), and NIHSS Score (neurologic, higher scores worse). Weighted linear regression models were used to assess the effect of immigration status on the outcomes. Analysis was completed using multiple imputation and inverse probability weighting to account for differential attrition. Results: Of 935 Mexican Americans available for analysis, 83 were immigrants and 852 were non-immigrants. Immigrants had resided in the U.S. on average 47 years. Immigrants were significantly older (69 vs. 66 years), more likely male (60% vs. 49%), more likely to have atrial fibrillation and have less education than non-immigrants (all p<0.05). No differences in hypertension, diabetes, cholesterol, insurance, smoking or other comorbidities existed. The Table provides the data from the fully adjusted models. Immigrants had better functional outcome (mean difference (MD) = -0.22; p=0.02), and no difference for neurologic outcome (MD= -0.15; p=0.15). There was an association of worse cognitive outcome in immigrants (MD= -5.25; p=0.009), however, the association was explained by attenuated after the adjustment for the lower educational attainment in immigrants (MD= -0.79; p=0.64). Conclusions: In this community, there was no evidence of worse stroke outcome among Mexican American immigrants, who had lived in the U.S. for decades, compared with non-immigrants. Further studies of more recent immigrant populations are warranted.

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Abstract TMP44: Ethnic Differences in Informal Caregiving After Stroke: The Brain Attack Surveillance in Corpus Christi (BASIC) Project

Stroke ◽

10.1161/str.51.suppl_1.tmp44 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Cecilia N Hollenhorst ◽

Lynda D Lisabeth ◽

Linda C Gallo ◽

Chia-Wei Hsu ◽

Sehee Kim ◽

...

Keyword(s):

Marital Status ◽

Ethnic Differences ◽

Mexican Americans ◽

Stroke Care ◽

Informal Caregiving ◽

Population Based ◽

Chi Square ◽

Population Based Study ◽

Corpus Christi ◽

Occupational Goals

Background and Aims: We studied informal (non-paid) caregiving after stroke in a population-based study to determine if differences occurred between Mexican Americans (MAs) and non-Hispanic whites (NHWs). MAs are a less affluent population than NHWs. Family members who provide caregiving may need to interrupt educational and occupational goals to provide this care, which may perpetuate socioeconomic disparities between minority and majority populations. Methods: Between October, 2014 and December, 2016, stroke subjects in Texas, USA, were interviewed 90 days after stroke to determine if family or friends provided informal, unpaid caregiving, and for which activities of daily living (ADLs) they required help. Chi-square tests were used to assess the association of ethnicity and whom provided the caregiving, as well as ethnicity and the ADLs for which they required help. Ethnic differences between MAs and NHWs in receiving informal caregiving were determined using logistic regression. The odds ratio (OR, 95% CI) is reported with NHW as the referent group. Results: 473 subjects answered the caregiving questions. There were no significant differences among the two ethnic groups with respect to age, sex, NIHSS score, marital status, or insurance. MAs were more likely to require help compared with NHWs for walking (p=0.0008), bathing (p=0.0004), hygiene (p=0.0018), eating (p=0.0059), dressing (p<0.0001), moving (p=0.0015) and toileting (p=0.0007). Among all subjects, 144 (30%) received informal caregiving (35% of 300 MAs versus 22% of 173 NHWs). There were no significant ethnic differences among which family member provided the caregiving. MAs were more likely to have informal caregiving OR=1.87 (95% CI 1.11-3.13) adjusted for age, sex, NIHSS, education, insurance and marital status. Conclusions: In this population-based study, MAs required more help than NHWs for assistance with ADLs, and MAs were more likely to receive this help through informal, unpaid caregiving than NHWs. Efforts to help minority and low-resource populations provide stroke care are needed.

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Abstract T P331: Investigating the Association of Traumatic Brain Injury and Ischemic Stroke in a Population-based Study

Stroke ◽

10.1161/str.45.suppl_1.tp331 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nelda Garcia ◽

James Burke ◽

Lynda D Lisabeth ◽

Brisa Sanchez ◽

Lewis B Morgenstern

Keyword(s):

Traumatic Brain Injury ◽

Ischemic Stroke ◽

Brain Injury ◽

Administrative Data ◽

Strong Association ◽

Population Based ◽

Time Interval ◽

Population Based Study ◽

Corpus Christi ◽

History Of

Background: Recently, two publications, one from California and one from Taiwan, utilizing administrative data have shown an independent, strong association between traumatic brain injury (TBI) and ischemic stroke (IS). The California analysis suggested TBI was a stronger risk factor for IS than hypertension. To begin the process of assessing whether TBI is really associated with IS with more definitive study types, we assessed the feasibility of obtaining TBI information in a population-based stroke study and characterized the history of TBI among IS patients including the time interval from TBI to stroke. Methods: As part of the Brain Attack Surveillance in Corpus Christi Project (BASIC), IS patients (n=439) who completed an interview were asked whether they had ever had a TBI that caused them to lose consciousness. For those IS patients who did have a TBI, we further questioned them as to the number and dates of TBIs and the length of loss of consciousness for the longest event. These questions closely followed the US Department of Defense characterization of TBI. Descriptive statistics were used to summarize history of TBI. Results: From 1/2/12 thru 7/7/13, 101 of the 439 (23%) IS stroke patients reported a history of at least one TBI that caused them to lose consciousness. Among patients with TBI, 67% had one TBI, 21% had 2 TBI’s, 10% had 3 or more TBI’s. The median length of time between the last reported TBI and stroke onset was 32 years (Q1: 7 years, Q3: 46 years); 3% had a TBI within 30 days prior to their IS and 9% had TBI within 1 year prior to their IS. The median NIHSS of IS patients with TBI was 3 (Q1: 1, Q3: 8) compared with a median NIHSS of 4 (Q1: 2, Q3: 9) among IS patients without TBI. Conclusion: It is feasible to obtain TBI information in this population-based stroke surveillance study where a history of TBI is very common in IS patients. The long interval between TBI to IS suggests a lack of association in most cases. A case-control study would be needed to confirm or refute the striking association of TBI and IS previously seen in administrative data. Further, a population-based study with detailed data collection would allow for discovery of associated mechanisms linking TBI to stroke such as dissection, coagulation disorders and intoxications.

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Abstract TMP76: Ischemic Stroke Location and Vascular Risk in Dizziness Visits and The Follow-up Period: A Population-based Study

Stroke ◽

10.1161/str.51.suppl_1.tmp76 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kevin A Kerber ◽

James Burke ◽

Lewis Morgenstern ◽

Devin Brown ◽

Thomas McLaughlin ◽

...

Keyword(s):

Ischemic Stroke ◽

Posterior Fossa ◽

Population Based ◽

Preventive Therapy ◽

Atherosclerotic Cardiovascular Disease ◽

Vascular Risk ◽

Corpus Christi ◽

Time Period ◽

Increased Risk

Objective: Prior studies found a concerning frequency of missed ischemic stroke among Emergency Department (ED) dizziness visits. We aim to describe details about the location of infarction (identified at ED dizziness visits or in the follow-up time period) and vascular risk. These data could inform opportunities to identify index strokes or reduce the risk of subsequent events. Methods: From October 2016 to April 2018, ED visits for dizziness, vertigo, or imbalance were identified in Nueces County, Texas. Validated index or subsequent 90-day ischemic stroke events were identified by linkage to the Brain Attack Surveillance in Corpus Christi (BASIC) project. Infarct locations were classified using imaging reports. The proportion of the events associated with Atherosclerotic cardiovascular disease (ASCVD) score ≥0.10, a common trigger for preventive therapy, was summarized. Results: There were 55 ischemic strokes identified at the time of the ED dizziness visit and 33 ischemic strokes identified in the subsequent 90-days. The Figure displays infarct location, days since ED visit, and ASCVD score. Posterior fossa infarction comprised 47% (26/55) (17 cerebellar, 9 brainstem) of the strokes identified at the dizziness visit and 39% (13/33) (11 cerebellar, 5 brainstem) of the strokes in the follow-up period. Baseline ACSVD scores were ≥0.10 in 78% (43/55) of patients with stroke identified at the dizziness visit and 79% (26/33) of patients with stroke identified in the subsequent 90-days. Conclusions: Posterior fossa lesions account a minority of the ischemic strokes that present to the ED with dizziness or occur in the subsequent 90-days. A substantial majority of these strokes have ASCVD scores higher than a common threshold for preventative therapies. Vascular risk assessment during ED dizziness visits might help providers to both diagnose acute strokes and to prompt preventative strategies in presumed non-stroke cases at increased risk for short-term stroke.

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Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project

Stroke ◽

10.1161/str.46.suppl_1.tp128 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Sarah Reeves ◽

Micah Aaron ◽

Michael Fuentes ◽

Lewis Morgenstern ◽

Lynda Lisabeth

Keyword(s):

Ethnic Differences ◽

Mexican Americans ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

Population Based ◽

Stroke Survivors ◽

Market Area ◽

Post Stroke ◽

Corpus Christi ◽

Rehabilitation Facilities

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community. Methods: Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey. Results: A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs. Conclusions: Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.

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