Disparities in Access to Acute Stroke Evaluation Across Tribal Communities in Minnesota, North Dakota, and South Dakota: Implications for Telestroke Integration

Indigenous communities living on tribal lands may face structural barriers to timely stroke evaluation due to geographic isolation and variability in local healthcare infrastructure. The extent of telestroke integration within IHS facilities in the Upper Midwest remains poorly defined. We performed regional infrastructure analysis of stroke care access across tribal lands in MN, ND, and SD using publicly available data sources. IHS facility directories were reviewed to identify hospitals and clinics serving tribal communities. Facility characteristics including emergency services, telehealth programs, and reported imaging capabilities were abstracted. State stroke designation lists were used to identify Acute Stroke Ready Hospitals (ASRH), Primary Stroke Centers, Thrombectomy-Capable Stroke Centers, and Comprehensive Stroke Centers in MN and ND; in SD, where a standardized ASRH list is not available, nearby hospitals with CT capability and stroke services were identified. Travel time estimates from reservations to the nearest stroke-capable facility were derived using mapping tools incorporating road networks and travel speeds. CDC county-level stroke mortality data were analyzed to evaluate regional burden and temporal trends, including comparison of overall mortality patterns and those affecting counties with tribal populations. At least 28 IHS and tribal facilities were identified across the study region. Approximately 30% publicly reported CT capability. Telehealth services were widely described; however, public documentation of telestroke capability was limited. Many facilities rely on interfacility transfer. Using centroid-based travel modeling, mean times to the nearest ASRH from tribal land were estimated at 50 minutes in MN, 42 minutes in ND, and 45 minutes in SD. Counties encompassing tribal lands demonstrated higher stroke mortality and persistent increases over time despite advances in stroke therapy. Significant structural gaps in stroke care access persist across tribal communities in the Upper Midwest, underscoring the need for improved telestroke integration, reliable imaging access, and stronger regional coordination.