Background and Aims

Access to acute stroke treatment is limited, particularly in low- and middle-income countries. Geomapping of stroke centers using reproducible algorithms could help design stroke systems of care, especially in regions where resources are limited.

Methods

We collected data on stroke centers from all MT2020+ regional committees in India. The geospatial files with the administrative boundaries and transportation layers were obtained from the Survey of India website. Centroids of the polygons and geographic coordinates were generated. MT-capable stroke centers were geocoded using the Google Geocoding application programming interface (API) and passed to the Google Distance Matrix API to estimate the distance and driving time. All analyses were performed using reproducible algorithms in R version 4.05.

Results

Maps demonstrating country-level travel times to the nearest MT-center from sub-district centroids and Kerala state level travel times to the nearest MT center from population centers were generated (Fig. 1,2,3, and 4).

Figure 1. Travel times to the nearest MT-capable center from sub-district centroids (India)

Figure 2. Distribution of stroke centers in Kerala (IVT- intravenous thrombolysis, EVT - endovascular treatment)

Figure 3. Distribution of population centers (grey) in relation to the stroke centers (red) in Kerala

Figure 4. Travel times to the nearest stroke center from population centers (Kerala)

Conclusions

The 60-minute access to an MT-capable center in India is extremely low. Geomapping analysis using reproducible algorithms could provide valuable information to policymakers in designing stroke services and could potentially be implemented in other regions of the world.