Geo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers

• Published in: International journal of stroke 2024-12, p.17474930241312598
• Main Authors: Asif, Kaiz, Mitra, Arun, Ortega-Gutierrez, Santiago, Herial, Nabeel A, Desai, Shashvat Monal, Jadhav, Ashutosh, Al-Mufti, Fawaz, Roy, Adrija, Singh, Romil, Brown, Grant, Sarraj, Amrou, Jose, Arun, Alurkar, Anand, Karapurkar, Anil, Sharma, Arvind, Gupta, Vipul, Goel, Gaurav, Khurana, Dheeraj, Das, Biplab, Roy, Jayanta, Das, Deep, Kumar, Rahul, Kuruttukulam, Gigy, Pradeep Kumar, V G, Srivastava, Padma Mv, Pandian, Jeyaraj Durai, Huded, Vikram, Yavagal, Dileep, Soman, Biju, Sylaja, P N
• Format: Article
• Language: English
• ISSN: 1747-4930; 1747-4949; 1747-4949
• DOI: 10.1177/17474930241312598

Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited. We evaluated the spatial distribution and geographic accessibility of stroke centers in India. Data on intravenous thrombolysis capable (IVT-C) and endovascular treatment capable (EVT-C) stroke centers were collected in March 2021 from thrombectomy devices and pharmaceutical industry providers, respectively. Data were collated and geocoded to compare and calculate zonal statistics and state/union territory (UT) summaries using descriptive statistics. Data on population centers were obtained from the Survey of India website. For estimating driving times, we used the Google Distance Matrix API to find the driving distance between each population center and its nearest stroke facility. Subsequently, population coverages were estimated as a proportion of the population having access to stroke centers for each time interval and based on the population projection for the year 2020 and compared across states. A total of 566 IVT-C stroke centers were spread across 26 states and UTs of which 361 (63%) were EVT-C. Ten UTs lacked stroke centers. The average stroke centers per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Median distances to the nearest IVT-C and EVT-C centers were 115 km (IQR 66-175) and 131 km (IQR 79-198), respectively. Access within one hour to an IVT-C and an EVT-C center was available to 26.3% and 20.6% of the Indian population, respectively. Access to stroke care in India is poor, with critical regional disparities as reflected by the low number of SCPM population, long driving times, and a small population with access within the golden hour. There is an urgent need to establish IVT and EVT-capable stroke centers in the existing poorly served regions of India to increase access and improve outcomes for stroke patients.