# Racial and ethnic disparities in access to acute stroke capabilities in California: Association with rurality and telestroke access

## TL;DR

The study finds that rural patients in California have less access to stroke care, and urban Hispanic and Black patients also face disparities.

## Contribution

The study reveals how rural location and urban race/ethnicity affect access to acute stroke care in California.

## Key findings

- Most California EDs have acute stroke capabilities, but rural patients have lower odds of access.
- Urban Hispanic and non-Hispanic Black patients have lower odds of accessing stroke-capable EDs compared to urban non-Hispanic Whites.
- Telestroke access does not reduce racial/ethnic disparities in urban areas.

## Abstract

We sought to examine the relationship between patient race/ethnicity and presentation to an emergency department (ED) with acute stroke capabilities, and whether this varied by rurality and telestroke access.

All acute ischemic stroke encounters in California in 2021 were obtained from California Department of Health Care Access and Information data. ED capabilities were from the 2021 National ED Inventory-USA database. Acute stroke capability was defined as having acute stroke ready status (or higher), telestroke or both. We examined the association between race/ethnicity and presentation to an ED with acute stroke capabilities, overall and stratified by rurality. Sensitivity analyses removed telestroke from our definition of acute stroke capability.

In 2021, 264 of 325 California EDs (81%) had acute stroke capabilities, 41 (13%) via telestroke alone. Only 2,050 of 63,252 encounters (3%) presented to an ED without capabilities. Rural (versus urban) patients had lower odds of access to acute stroke capabilities, regardless of telestroke status. There were no differences in access by race/ethnicity for rural patients, but urban Hispanic, non-Hispanic Black and patients of other race had lower odds of access (versus urban non-Hispanic Whites) regardless of telestroke status.

Most California EDs have acute stroke capabilities. While few patients presented to non-capable centers, rural patients had lower odds of access. Racial/ethnic disparities differed between urban and rural settings, with lower odds of access for Hispanic and non-White urban patients but no significant differences by race/ethnicity in rural patients, however this latter finding might reflect limited power due to smaller sample sizes. ED telestroke capability did not reduce disparities in access.