Supplementary Material for: Breaking Paradigms: Mexico’s Stroke Roadmap Assessing Institutional Resources Using World Stroke Organization Stroke-Certification Parameters

Introduction:
This study provided a comprehensive assessment of the geographic distribution and accessibility of stroke care resources in Mexico’s public health system. The World Stroke Organization (WSO) roadmap criteria classifies centers offering only intravenous thrombolysis as Essential Stroke Centers (ESCs) and those providing both thrombolysis and mechanical thrombectomy as Advanced Stroke Centers (ASCs). Despite recent progress, substantial disparities in access have persisted, particularly between the remote and underserved areas.
Methods
This cross-sectional study evaluated institutional resources for acute stroke care across public hospitals in Mexico. A structured online survey developed by the Deputy Secretariat for Health Policy and Population Well-Being in collaboration with experts was based on the WSO Roadmap and aligned with the institutional protocols.
The instrument was validated by healthcare professionals and distributed via institutional email to the medical directors of IMSS, ISSSTE, IMSS-Bienestar (including the National Institutes of Health), PEMEX, and SEMAR. Data were collected between December 5, 2024, and January 25, 2025. Duplicate entries, nonhospital responses, and uncertified neurointerventional specialists were excluded. The analysis was restricted to general and regional hospitals, and eligible facilities were identified and validated against the Ministry of Health’s Catalogue of Health Establishments. All hospitals were georeferenced using the CLUES code and classified as ESCs or ASCs according to the WSO Roadmap criteria.
Results
In total, 1,032 facilities across 32 federal entities completed the survey. Hospitals without diagnostic or therapeutic capacity for stroke were excluded from further analysis. Isochrones were generated using national road network data and the estimated average travel speeds for different road types under normal conditions. Eighty-five percent of at-risk individuals reside within 60 minutes of an ESC, ensuring access to fibrinolytic therapy. In contrast, 14% of individuals aged ≥40 years (6,312,370 people) live more than 60 min from the nearest ESC. Despite advances in acute ischemic stroke (AIS) care, more than half of the population aged ≥40 years remains over one hour away from an ASC, highlighting critical “stroke care deserts,” particularly in access to thrombectomy, most notably in Colima, Nayarit, Oaxaca, Guerrero, Veracruz, and Sinaloa.
Conclusions:
Strengthening universal stroke care through interinstitutional collaboration, standardized protocols, certification programs, and optimization of referral networks could enable up to 85% of the at-risk population to access effective treatment at certified stroke centers. Our analysis highlights the major infrastructural and logistical barriers that impede equitable access to life-saving endovascular therapies. Addressing these gaps is essential to reduce mortality and disability in Mexico’s heterogeneous public health system.