Bridging the Rural-urban Divide in Stroke Care: Evaluating Statewide Accessibility and Distribution in Oklahoma
Daniela Mercado Pena1, Leonardo Carbonera3, Melba Maria Zuniga Gutierrez1, María Cedeño-Bruzual1, Ana Claudia De Souza3, Briana Liu1, Sophia Lee4, Laura Boada Robayo1, Leonardo Dorneles5, Mateus Boiani5, Marcio Dorn5, André da Silva Frainer5, Sheila Martins6, Daniel Vizcaya7, Hyatt Saleh Velez7, Camila Bonin Pinto2, Faddi Saleh Velez1
1Neurology, 2Neurosurgery, Brain Stimulation and Neurorehabilitation Laboratory, University of Oklahoma Health Campus, 3Neurology and Neurosurgery, Hospital Moinhos de Vento, 4College of Medicine, University of Oklahoma, 5Federal University of Rio Grande do Sul, 6Hospital de Clinicas Porto Alegre, 7The Mad Fox
Objective:
This study aims to evaluate the accessibility of acute stroke care across Oklahoma, identifying geographic and resource-based disparities that disproportionately affect rural populations, with the goal of developing strategies to achieve statewide, equitable stroke care access.
Background:
Stroke is a time sensitive medical emergency requiring rapid diagnosis and treatment. However, access to specialized care remains uneven across Oklahoma. Rural regions face the greatest disadvantage due to the unequal distribution of comprehensive stroke centers and limited availability of advanced interventions, leaving rural residents without access to timely, lifesaving reperfusion therapies.
Design/Methods:
Stroke related resources and population accessibility were assessed across all hospitals in Oklahoma. Each hospital’s geographic coordinates were obtained using Google Maps, and catchment areas were defined by a 30-minute driving radius using Openrouteservice, which generates isochrones, polygonal boundaries representing areas reachable within the established time frame. Rural–Urban Commuting Area (RUCA) codes were used for urban-rural classification. Travel distances to the nearest three hospitals able to provide acute reperfusion therapy were calculated using Google Maps.
Results:
A total of 164 hospitals were identified: per 2020 RUCA codes 50.6% (83) were urban, 48.2% (79) rural, and 1.2% (2) unknown (excluded from analysis). Only 17.7% had stroke certification, mainly concentrated in Oklahoma City and Tulsa, although certification rate did not differ significantly by rurality (16.9% rural vs 19.0% urban, p=0.839). Among urban facilities, Comprehensive Stroke Centers predominated (53.3%) whereas rural hospitals were primarily Acute Stroke Ready Centers (53.3%). Thrombectomy availability differed significantly: 0 rural (0.0%) vs 10 urban (12.7%), Fisher p=0.0006335.
Conclusions:
These findings highlight the persistent rural urban divide in stroke care across Oklahoma. Expanding telemedicine networks, optimizing EMS triage and transfer protocols, exploring cross state collaboration, and strategically developing new stroke centers guided by spatial modeling tools such as the MAPSTROKE project are critical to improve statewide stroke care equity.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.