Critical Stroke Care Less Likely in Disadvantaged Areas

TOPLINE:

Hospitals serving predominantly Black and socioeconomically disadvantaged communities were 32% less likely to administer intravenous thrombolysis (IVT) for acute ischemic stroke than hospitals serving more affluent communities, a new study showed.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using US hospital data from the 2016-2020 National Inpatient Sample database.
• Nearly 2.5 million patients with acute ischemic stroke (mean age, 70.1 years; 50.2% men) were included. Of these, 68.2% were White, 17.4% were Black, 8.2% were Hispanic, 3.1% were Asian or Pacific Islander, 0.5% were American Indian, and 2.6% were of other races or ethnicities.
• Investigators used the Index of Concentration at the Extremes (ICE) to measure hospital-level segregation.
• The primary outcome was the rate of IVT administration; secondary outcomes included racial and ethnic disparities in this administration across ICE quintiles.

TAKEAWAY:

• 65% of participants were treated at hospitals in the third ICE quintile, which serve patients with a balanced mix of racial backgrounds and incomes, whereas only 1% were treated at hospitals in the first quintile, which serve predominantly Black and socioeconomically disadvantaged patients.
• Patients at hospitals in the fourth and fifth quintiles (serving moderately and predominantly White and socioeconomically advantaged patients, respectively) were significantly more likely to receive IVT compared with those in first-quintile hospitals (adjusted odds ratio [AOR], 1.32 and 1.27, respectively; both, P < .001).
• In the first quintile, Black patients were less likely than White patients to receive IVT (AOR, 0.68; P < .001). Although the extent of this racial disparity decreased in hospitals in higher ICE quintiles, the disparity persisted across all levels.

IN PRACTICE:

“Socioeconomic improvements were associated with reduced, but not eliminated, racial and ethnic disparities in stroke treatment. Addressing structural racism and segregation is crucial for equitable access to stroke care,” the investigators wrote. 

SOURCE:

The study was led by Jean-Luc K. Kabangu, MD, University of Kansas Medical Center, Kansas City, Kansas. It was published online on February 28 in JAMA Network Open.

LIMITATIONS: 

The study’s reliance on administrative data may have introduced coding errors, and ICE calculations may not have fully captured segregation complexities. Unmeasured confounding factors could have influenced the results, and the retrospective design limited the ability to establish causal inference. The findings were also not generalizable to settings outside the United States.

DISCLOSURES:

One investigator reported serving as a consultant for various medical device companies, receiving royalties from Springer-Verlag, and serving on the advisory board for and being an investor in MSKai outside the submitted work. Although specific funding information was not provided for the study, the investigators reported receiving resources and materials for the study from the University of Kansas Medical Center and Semmes Murphey Clinic.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.