{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:16:28Z","timestamp":1777670188116,"version":"3.51.4"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Time from stroke onset to hospital arrival determines treatment and impacts outcome. Structural, socioeconomic, and environmental factors are associated with health inequity and onset-to-arrival in adult stroke. We aimed to assess the association between health inequity and onset-to-arrival in a pediatric comprehensive stroke center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A retrospective observational study was conducted on a consecutive cohort of children (&gt;28 days\u201318 years) diagnosed with acute arterial ischemic stroke (AIS) between 2004 and 2019. Neighborhood-level material deprivation was derived from residential postal codes and used as a proxy measure for health inequity. Patients were stratified by level of neighborhood-level material deprivation, and onset-to-arrival was categorized into 3 groups: &lt;6, 6 to 24, and &gt;24 hours. Association between neighborhood-level material deprivation and onset-to-arrival was assessed in multivariable ordinal logistic regression analyses adjusting for sociodemographic and clinical factors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Two hundred and twenty-nine children were included (61% male; median age [interquartile range] at stroke diagnosis 5.8-years [1.1\u201311.3]). Over the 16-year study period, there was an increase in proportion of children diagnosed with AIS living in the most deprived neighborhoods and arriving at the emergency room within 6 hours (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.01). Among Black patients, a higher proportion lived in the most deprived neighborhoods (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.02) and level of material deprivation was associated with AIS risk factors (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Our study suggests an increase in pediatric stroke in deprived neighborhoods and certain communities, and earlier arrival times to the emergency room over time. However, whether these changes are due to an increase in incidence of childhood AIS or increased awareness and diagnosis is yet to be determined. The association between AIS risk factors and material deprivation highlights the intersectionality of clinical factors and social determinants of health. Finally, whether material deprivation impacts onset-to-arrival is likely complex and requires further examination.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.123.045411","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T12:56:29Z","timestamp":1710507389000},"page":"1299-1307","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Health Inequity and Time From Pediatric Stroke Onset to Arrival"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2266-8821","authenticated-orcid":true,"given":"Akshat M.","family":"Pai","sequence":"first","affiliation":[{"name":"Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"To","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada."},{"name":"Dalla Lana School of Public Health (T.T.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9584-0576","authenticated-orcid":true,"given":"Gabrielle A.","family":"deVeber","sequence":"additional","affiliation":[{"name":"Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Nichol","sequence":"additional","affiliation":[{"name":"Neurosciences &amp; Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Kassner","sequence":"additional","affiliation":[{"name":"Division of Translational Medicine (A.K.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada."},{"name":"Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5306-7549","authenticated-orcid":true,"given":"Birgit","family":"Ertl-Wagner","sequence":"additional","affiliation":[{"name":"and Division of Neuroradiology (B.E.-W.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Department of Medical Imaging (A.K., B.E.-W.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3922-1225","authenticated-orcid":true,"given":"Mubeen F.","family":"Rafay","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurology, Department of Pediatric and Child Health, University of Manitoba, Winnipeg, Canada (M.F.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5927-3132","authenticated-orcid":true,"given":"Nomazulu","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Neurosciences &amp; Mental Health Program, Research Institute (D.N., N.D.), The Hospital for Sick Children, Toronto, Canada."},{"name":"Institute of Medical Science (A.M.P., T.T., G.A.V., A.K., N.D.), University of Toronto, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Social determinants of health - healthy people 2030 | health.gov. Accessed November 27 2020. https:\/\/health.gov\/healthypeople\/objectives-and-data\/social-determinants-health"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.028530"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002065"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005946"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31828154ae"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003266"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00200-8"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"e_1_3_3_11_2","unstructured":"English indices of deprivation. GOV.UK. 2019. Accessed August 29 2023. https:\/\/www.gov.uk\/government\/collections\/english-indices-of-deprivation"},{"key":"e_1_3_3_12_2","first-page":"157","article-title":"Use of postal codes and addresses in the analysis of health data.","volume":"5","author":"Wilkins R","year":"1993","unstructured":"Wilkins, R. Use of postal codes and addresses in the analysis of health data. Health Rep. 1993;5:157\u2013177.","journal-title":"Health Rep"},{"key":"e_1_3_3_13_2","unstructured":"Government of Canada SC. Census dictionary 2016. Accessed January 7 2022. https:\/\/www12.statcan.gc.ca\/census-recensement\/2016\/ref\/dict\/index-eng.cfm"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.02.018"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012676"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017264"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2020.08.008"},{"key":"e_1_3_3_18_2","unstructured":"Government of Canada SC. Statistics Canada: about us. 2008. Accessed January 7 2022. https:\/\/www.statcan.gc.ca\/en\/about\/about"},{"key":"e_1_3_3_19_2","unstructured":"Postal code conversion file | map and data library. Accessed January 7 2022. https:\/\/mdl.library.utoronto.ca\/collections\/numeric-data\/census-canada\/postal-code-conversion-file"},{"key":"e_1_3_3_20_2","unstructured":"Esri Canada. Topographic\/topographie. Accessed December 21 2022. https:\/\/www.arcgis.com\/home\/item.html?id=98652eb8458a464fa95feb9bd812b29a"},{"key":"e_1_3_3_21_2","unstructured":"Greater Toronto Area (GTA) Boundary. 2012. Accessed August 9 2023. http:\/\/geo.scholarsportal.info\/#r\/details\/_uri@=4237866196"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.607192"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.633305"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25718"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22224"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.519066"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13214"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.13063\/2327-9214.1035"},{"key":"e_1_3_3_29_2","unstructured":"Sjoberg DD Larmarange J Curry M Lavery J Whiting K Zabor EC Bai X Drill E Flynn J Hannum M et al. Gtsummary: presentation-ready data summary and analytic result tables. 2023. Accessed August 13 2023. https:\/\/cran.r-project.org\/web\/packages\/gtsummary\/index.html"},{"key":"e_1_3_3_30_2","unstructured":"Wickham H RStudio. tidyverse: easily install and load the \u201cTidyverse\u201d. 2023. Accessed August 13 2023. https:\/\/cran.r-project.org\/web\/packages\/tidyverse\/index.html"},{"key":"e_1_3_3_31_2","unstructured":"Kassambara A. ggpubr: \u201cggplot2\u201d based publication ready plots. 2023. Accessed August 13 2023. https:\/\/cran.r-project.org\/web\/packages\/ggpubr\/index.html"},{"key":"e_1_3_3_32_2","unstructured":"Government of Canada SC. 2021 census of population key indicators by geography: Ontario. 2022. Accessed April 22 2022. https:\/\/www12.statcan.gc.ca\/census-recensement\/stats\/statgeo2021.cfm"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21781"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03512-8"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2009.25"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.624585"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013544"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7354.17"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0196-0644(99)70431-2"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000165951.03373.25"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.228"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2008.03012.x"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2021.27"},{"key":"e_1_3_3_44_2","unstructured":"International alliance for pediatric stroke. Accessed August 9 2023. https:\/\/iapediatricstroke.org\/mission-vision-values\/"},{"key":"e_1_3_3_45_2","unstructured":"Canadian pediatric stroke support association. Accessed August 9 2023. http:\/\/cpssa.org\/mission.htm"},{"key":"e_1_3_3_46_2","first-page":"29","article-title":"Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke.","volume":"23","author":"Siegler JE","year":"2013","unstructured":"Siegler, JE, Boehme, AK, Albright, KC, Martin-Schild, S. Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke. Ethn Dis. 2013;23:29\u201334.","journal-title":"Ethn Dis"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.613828"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0027-9684(15)31483-8"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000918"}],"updated-by":[{"DOI":"10.1161\/str.0000000000000473","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000}}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.123.045411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T12:05:32Z","timestamp":1751285132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.123.045411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":48,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1161\/STROKEAHA.123.045411"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.123.045411","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]},"assertion":[{"value":"2023-10-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-30","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}