Objective:

To leverage geospatial mapping techniques in order to identify and address stroke disparities at a local level.

Background:

Social Vulnerability Index (SVI) is a community-level geospatial indicator which correlates with incidence and severity at time of presentation in Acute Ischemic Stroke (AIS). Early bystander recognition of AIS symptoms is a major barrier to timely delivery of acute stroke therapies- interactive family/bystander educational initiatives, particularly those targeting school-age individuals, are effective in addressing this barrier.

Design/Methods:

ArcGIS pro was used to overlay County-level U.S. stroke death and hospitalization rates (CDC dataset) with census tract level CDC/ATSDR SVI data within a 30mile radius of two academic hospital system hubs.  Zip codes were cross-walked with census tracts (HUD User datasets). Rstudio was used to analyze associations between county level stroke hospitalization rates, mortality rates, and differences in stroke hospitalization and mortality, respectively, with SVI percentiles. Areas with low hospitalization and high mortality were ranked within the designated radius. Local schools within the most impacted regions were identified.

Results:

Stroke mortality rates within the designated radius of our hospital hubs ranged from 66.6-102.8/100K 34-65yo persons and 187.3-359.9/100K ≥65yo persons. Differences between hospitalization and mortality for persons ≥65yo ranged from 521-880.1/100K persons.  Spearman rank correlation analysis showed a significantly positive correlation between county SVI and stroke mortality for persons 35-64yo within our designated radius (r_s=0.75, n=10, p=0.01). There was also a positive correlation between county SVI and stroke hospitalization rates (r_s=0.64, n=10, p=0.046).

Conclusions:

Using geospatial mapping, this study strategically identified schools and community centers within areas of high SVI burden and associated stroke hospitalization/mortality. This highlights geospatial mapping as a useful tool in addressing local stroke disparities via its ability to identify high impact locations for the development and implementation of family/bystander-facing educational initiatives regarding stroke recognition and awareness.