Acute stroke is the leading neurological cause of death and disability. After years of therapeutic nihilism there is now some optimism that effective treatments might become more widely available. It appears likely that very early thrombolysis is of benefit, 1 and there is good evidence for the use of aspirin. 2 As well as gains from the early initiation of these “disease modifying” treatments, it is likely that early admission to a safe clinical environment, with attention to simple physiological variables such as temperature and blood glucose, will improve outcome. 3 For these reasons, it seems probable that the time taken for patients to reach hospital following stroke onset will have a significant effect on outcome.

We have shown higher rates of intensive care admission for epilepsy, stroke, or head injury among individuals from affluent areas. 4 The impact of social deprivation on disease management might result from biases within health care systems, or from differences in how individuals perceive disease and access health care systems, and in particular how quickly they access care. As acute stroke services are developed to meet the challenges ahead, any impact of deprivation on the delay to treatment should be identified. We have examined time to hospital admission by deprivation category for patients enrolled in the Lothian stroke registry (LSR).