Disparities in Prehospital Stroke Care: Neighbourhood Socioeconomic Status and Delays in Hospital Presentation.

Purpose: Socioeconomic status (SES) is known to influence health outcomes. We investigated whether prehospital time-metrics are associated with neighbourhood SES (nSES) in a cohort of patients with neurological symptoms suspect for stroke from two regions in the Netherlands. Method: We analysed data from two prospective cohort studies. As a proxy for nSES, we used a postcode-based composite score as developed by “Statistics Netherlands”(CBS) with a range from -1 to 1. The associations between nSES and time metrics were examined through linear regression. Logistic regression estimated the association with final stroke diagnoses and receiving reperfusion treatment. Models were fit using generalized estimating equations. All analyses were adjusted for age, sex and original study. Findings: The cohort included 2854 patients (1485 52.0% male, median age 73 IQR 61-81, median baseline NIHSS score 2 IQR 0-6). nSES was associated with onset-to-alarm-time (aβ -0.26 (95%CI -0.49 to -0.03, p=0.03)) and onset-to-door-time (aβ -0.21 95%CI -0.36 to -0.05, p=0.01), with a respective 23% and 19% increase per 1 point shift towards a more deprived nSES. However, nSES was not associated with alarm-to-door-time (aβ -0.01 95%CI -0.07 to 0.05, p = 0.79), final stroke diagnosis (aOR 0.91 95%CI 0.66 to 1.35) or likelihood of receiving reperfusion therapy (aOR 1.16 95%CI 0.79 to 1.70). Discussion and conclusion: Living in a more socioeconomically deprived neighbourhood is associated with pre-hospital delays for patients presenting with neurological symptoms suspect for stroke. This highlights the importance of examining barriers to timely EMS activation and formulating strategies to reduce socioeconomic disparities in stroke response.