Introduction: The proposed research examines the association between neighborhood socioeconomic status (NSES) and prehospital care provided in Los Angeles County (LAC) by Emergency Medical Services (EMS).

Methods: This retrospective study used geocoded data from LAC EMS (2019 to 2022) linked to US Census data. NSES was defined as median income in the residential neighborhood. Prehospital care was assessed using mean EMS response time and symptom-onset to arrival time of less than one hour, a crucial time frame for stroke care. Multivariable regression models adjusted for age and gender were used to estimate differences in transit times between lowest and highest median household income quartiles.

Results: For 26,129 EMS unique stroke calls, mean EMS response time was 8.94 (SD 4.73) minutes in the highest NSES income quartile, compared to 7.86 (SD 4.34) minutes for the lowest quartile of median household income, P<0.001. In adjusted models, EMS response was longer in patients from the highest NSES quartile β=1.07 (95% CI 0.69-1.41, P<0.001) compared to the lowest quartile. In contrast, residents of communities in the highest NSES quartile had higher odds than those in the lowest quartile of arriving at the hospital within 1 hour of symptoms OR=1.3 (95% CI 1.01-1.39)

Conclusion: Compared to patients with stroke from low NSES communities, those from communities with a higher NSES had longer EMS response times but also had higher likelihood of hospital arrival within one hour of symptom onset. The disparity in early hospital arrival may be associated with delays in care that result in worse clinical outcomes.