Abstract DP206: Location, Location, Location: Examining Disparities in Access to Comprehensive Stroke Care

Background: Disparities in access to stroke care and stroke outcomes are well documented in the literature. However, research on differences in access to Comprehensive Stroke Centers (CSCs) is scant. Our objective was to analyze travel distance and travel time to CSCs for members of minority communities compared to non-minority communities in one urban county. Methods: A directory of all Los Angeles County Stroke Centers was obtained, and all CSCs were plotted using a geographic information system. Census data was used to create a list of all 121 cities and census designated places (CDPs) in Los Angeles County with a variety of demographic data including neighborhood majority race. Neighborhoods were classified into two groups: majority Black or Hispanic and majority white, Asian, or no majority. Travel distance was calculated along city streets from the center of each city and CDP to the closest CSC. Minimum and maximum travel times to that CSC was estimated at 0800, 1200, and 1700. Average distance, minimum, and maximum travel times were calculated for each neighborhood grouping and analyzed. Results: A one-way MANOVA demonstrated a significant multivariate effect of neighborhood majority race on travel metrics. Pillai’s Trace = 0.157, F (3, 117), p < 0.001, partial n2 = 0.157 There was a statistically significant difference in travel distance for residents of majority Black and Hispanic neighborhoods (M = 7.19, SD = 5.01) compared to residents of majority white, Asian, or no majority neighborhoods (M = 5.43, SD = 4.32). There was a statistically significant difference in minimum travel times for residents of majority Black and Hispanic neighborhoods (M = 13.8, SD = 6.2) compared to residents of majority white, Asian, or no majority neighborhoods (M = 11.2, SD = 5.9). There was a statistically significant difference in maximum travel times for residents of majority Black and Hispanic neighborhoods (M = 29.3, SD = 15.1) compared to residents of majority white, Asian, or no majority neighborhoods (M = 21.5, SD = 11.1). Conclusion: Our work suggests that interactions at the level of demographics, routing policy, and physical location of stroke centers disproportionately disadvantage members of majority Black and Hispanic communities. Specifically, residents of Black and Hispanic neighborhoods must travel further and for a greater duration to arrive at a CSC.