Stroke disparities in Florida: Examining the relationship between county classification, age-adjusted stroke mortality rates, and the presence of primary strok

Although overall stroke mortality has declined in the United States for decades, recent data show that this decline in stroke deaths has slowed and that stroke remains 1 of the leading causes of death at the state level (1). In Florida, stroke is the fifth leading cause of death and was responsible for 12,602 deaths in 2017. Florida’s death rate is 38.9 per 100,000 population and, in 2021, it is tied with Illinois at 20th place in stroke-related death rate rankings by state (2). As part of an effort to improve the quality of care provided to stroke patients, primary stroke centers were created with a strict set of criteria for certifying hospitals that meet predefined standards (3) with the goal of stabilizing and providing emergency care for acute stroke patients (4). With these goals in mind, a patient is admitted to a primary stroke center or a comprehensive stroke center based on the severity of stroke symptoms. Although comprehensive stroke centers are equipped to provide care for complex stroke patients who often have more advanced therapeutic needs, primary stroke centers are equipped to provide care for less complex stroke patients and can administer acute stroke thrombolysis in a timely manner. Having limited or no access to stroke centers remains a major challenge for many stroke patients. In the US, the scarcity of stroke centers is more pronounced in rural areas (5). In Florida, a rural county is a county with either 1) a population of 75,000 people or less, or 2) a population of less than 125,000 people and contiguous with a county that has a population of less than 75,000 people (6). By this definition, 30 out of the 67 counties in Florida are rural (7) and they contain 8.8% of Florida’s population (8). Considering the importance of stroke centers, a gap exists in the literature assessing the relationship between county classification, age-adjusted stroke mortality rates, and the number of primary stroke centers in Florida. The purpose of our research was to create maps that illustrate the relationship between age-adjusted stroke mortality rates and the presence of primary stroke centers in Florida. We hypothesized that stroke mortality will be higher in regions of Florida with fewer primary stroke centers.Journal ArticlePublishe