Evolution of endovascular stroke centers and disparities in access to stroke care in four Northeastern states: 2015-2019



      Disparities exist throughout our healthcare system, especially related to access to care. Advanced stroke care for strokes is only available at selected endovascular centers (ESCs) in the United States. Although the number of ESCs increase each year, this does not necessarily reflect increased access to care. Here, we look at the evolution of ESC in four states and disparities in access to advanced stroke care.

      Materials and methods

      This is a descriptive study of access to ESCs in four Northeastern states between 2015-2019. Using data from the United States Census Bureau and spatial analysis, we examined the proportion of the population with drive times of less than 60 minutes stratified by income, race/ethnicity, population density, and insurance. We also calculated the mean drive time for each of these socioeconomic groups from their census tracts to the nearest ESC.


      Between 2015 and 2019, the number of ESCs increased from 15 to 48. The proportion of patients within a 60-minute drive of an ESC increased from 77% to 88%. However, only 66% of the least densely populated quartile lived within 60 min of an ESC. By income, access to ESCs in the wealthiest quartile was 96.6% compared to 83.7% in the lowest quartile. Hispanics and non-Hispanic Blacks had the largest proportions of populations within 60 minutes of an ESC while Non-Hispanic Whites had the smallest.


      This study underscores the need to evaluate the placement of new ESCs to assure that these hospitals decrease disparities and increase access to advanced stroke care.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American heart association.
        Circulation. 2020; 141 (Mar 3): e139-e596
        • Centers for Disease Control and Prevention
        Underlying Cause of Death CWODA.
        Centers for Disease Control and Prevention, GA2019 (Accessed May 30, 2021)
        • Berkhemer O.A.
        • Fransen P.S.
        • Beumer D.
        • et al.
        A randomized trial of intraarterial treatment for acute ischemic stroke.
        N Engl J Med. 2015; 372 (Jan): 11-20
        • Campbell B.C.
        • Mitchell P.J.
        • Kleinig T.J.
        • et al.
        Endovascular therapy for ischemic stroke with perfusion-imaging selection.
        N Engl J Med. 2015; 372 (Mar): 1009-1018
        • Goyal M.
        • Demchuk A.M.
        • Menon B.K.
        • et al.
        Randomized assessment of rapid endovascular treatment of ischemic stroke.
        N Engl J Med. 2015; 372 (Mar): 1019-1030
        • Jovin T.G.
        • Chamorro A.
        • Cobo E.
        • et al.
        Thrombectomy within 8 hours after symptom onset in ischemic stroke.
        N Engl J Med. 2015; 372 (Jun): 2296-2306
        • Albers G.W.
        • Marks M.P.
        • Kemp S.
        • et al.
        Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging.
        N Engl J Med. 2018; 378 (Feb 22): 708-718
        • Adeoye O.
        • Albright K.C.
        • Carr B.G.
        • et al.
        Geographic access to acute stroke care in the United States.
        Stroke. 2014; 45 (Oct): 3019-3024
      1. Commission T.J. Quality check-organizations that have achieved the gold seal of approval from the joint commission. Accessed February 20, 2021.

        • Zachrison K.S.
        • Cash R.E.
        • Adeoye O.
        • et al.
        Estimated population access to acute stroke and telestroke centers in the US, 2019.
        JAMA Netw Open. 2022; 5e2145824
        • Yu C.Y.
        • Blaine T.
        • Panagos P.D.
        • Kansagra AP.
        Demographic disparities in proximity to certified stroke care in the United States.
        Stroke. 2021; 52 (Aug): 2571-2579
        • Rinaldo L.
        • Rabinstein A.A.
        • Cloft H.
        • Knudsen J.M.
        • Castilla L.R.
        • Brinjikji W.
        Racial and ethnic disparities in the utilization of thrombectomy for acute stroke.
        Stroke. 09 2019; 50: 2428-2432
        • Kim Y.
        • Sharrief A.
        • Kwak M.J.
        • et al.
        Underutilization of endovascular therapy in black patients with ischemic stroke: an analysis of state and nationwide cohorts.
        Stroke. 03 2022; 53: 855-863
      2. Commission T.J.. The joint commission stroke certification programs - program concept comparison. Updated April 20, 2021. Accessed March 1, 2020,

      3. Final Hospital Destination Capability List 2019. Delaware Department of Health. Accessed March 30, 2022,

      4. NYSDOH Stroke Designated Centers. New York State Department of Health. 2022,

      5. Designated Stroke Center Hospitals by County. State of New Jersey Department of Health. Accessed March 30, 2022,

      6. Recognized Stroke Centers. Pennsylvania Department of Health. Accessed March 30, 2022,

      7. Social Explorer Tables: ACS 2019 (5-Year Estimates) (SE), ACS 2019 (5-Year Estimates), Social Explorer; U.S. Census Bureau).

        • Adeoye O.
        • Nystrom K.V.
        • Yavagal D.R.
        • et al.
        Recommendations for the establishment of stroke systems of care: a 2019 update.
        Stroke. 2019; 50 (Jul): e187-e210
        • Jahan R.
        • Saver J.L.
        • Schwamm L.H.
        • et al.
        Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice.
        JAMA. 2019; 322 (Jul 16): 252-263