Abstract Number: Esoc2026a716 Longer Onset-to-Door Times in Non-White Patients in Italy: A Prospective, Multicentric Study on 2402 Patients

Abstract Background and aims Studies from the USA have reported lower access to reperfusion treatments (RTs) for Ischemic Stroke (IS) among racial/ethnic minorities; however, evidence from Italy is lacking. We aimed to assess the impact of race/ethnicity on RTS administration and onset-to-door time (ODT). Methods Consecutive adult patients with IS presenting to 14 Italian stroke centers between October 2024 and November 2025 were prospectively enrolled. Based on self-reported race/ethnicity, patients were classified as White or non-White. Outcomes were Intravenous Thrombolysis (IVT), Endovascular Treatment (EVT), and ODT. Associations between ODT and race/ethnicity were assessed using linear regression adjusted for demographics, comorbidities, baseline NIHSS, premorbid mRS, education level, mode of arrival, occupational status, language barriers, and cohabitation status. Logistic regressions adjusted for the same variables, plus large vessel occlusion, anticoagulant use, and ASPECTs were used to identify predictors of IVT and EVT. Results Overall, 2402 patients were enrolled in the study, of whom 2257 were Whites (94.0%). Overall, 830 patients (35.7%) received IVT and 648 (27.9%) EVT. Compared with White patients, non-White patients were younger (62.9±16.7 vs 74.1±13.9 years; p0.001) and less frequently women (33.8% vs 47.2%, p=0.002). White category was not associated with IVT and EVT administration (aOR 0.70 95%CI (0.34-1.67), p=0.497 and aOR 2.50 95%CI (0.84-7.40), p=0.098, respectively) but was independently associated with shorter ODT (aβ -631.69 95%CI (-1100.34 - -163.03); p=0.008). Conclusions Our study suggests that racial/ethnic disparities in timely access to stroke care exist even in countries with universal healthcare systems, highlighting the need for public health interventions. Conflict of interest Nothing to disclose