Significant Disparity of Access to Stroke Treatment Between the Western Parts and Eastern and Northern Parts of Sydney

Objective To provide an estimate of access times and distances to an endovascular clot retrieval (ECR) service provider for a typical stroke patient in the western part of Sydney and to compare it with the eastern and northern parts. Methods Incidences of stroke were simulated through a population-weighted randomized selection of addresses in the studied western, eastern, and northern areas of Sydney (100,000 times for each). The access times and distances were calculated from those addresses to the closest ECR hub for the eastern and northern parts and to all five ECR hubs, as well as the Nepean Public Hospital (NPH) for the western part. The access times and distance means were compared statistically using ANOVA. Results In the western areas, the estimated average access times and distances to different ECR hubs varied from 38.5 (+/- 15) to 45 (+/- 15) minutes and from 42 (+/- 15.9) to 46.8 (+/- 16) km in working hours and from 45 (+/- 15) to 64 (+/- 15) minutes and 46.8 (+/- 16) to 69.6 (+/- 16) km in after hours. However, the estimated average access times and distances to the local ECR hub were 12.25 (+/- 6) minutes and 9.1 (+/- 5.6) km for northern and 7.5 (+/- 4) minutes and 4.4 (+/- 2.5) km for the eastern areas. The differences between the estimated average access times and distances for a typical stroke patient to an ECR hub in the western areas in comparison with eastern or northern areas were statistically significant (p<0.0001). The average access times and distances in the western part to NPH were 17 (+/- 16) minutes and 15.6 (+/- 16.6) km. Conclusions The patients in the western part of Sydney had significantly longer access times to ECR hubs than those living in comparable areas of the eastern and northern parts. This study supports the Nepean Public Hospital supplying an ECR service to achieve travel times, and, therefore, treatment times for a typical stroke patient in the western parts, similar to patients in the eastern and northern parts of Sydney.