Uninsured Hispanics Less Likely to Get Post-Stroke Care

TOPLINE:

Uninsured Hispanic patients with stroke are less likely to receive post-acute care, with only 29% discharged to a facility compared with 37% of uninsured White patients, new research shows.

METHODOLOGY:

• To learn more about racial and ethnic disparities in post-acute service for patients with ischemic stroke and intracerebral hemorrhage (ICH), investigators used a 2017 and 2018 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project.
• NIS is the largest all-payer inpatient dataset in the United States, approximating a 20% stratified sample of patient hospitalizations in all the community hospitals in the United States.
• A total of 1,000,980 weighted ischemic stroke and 91,435 weighted ICH admissions were included. Discharge destinations were classified as facility, home healthcare (HHC), or home without HHC.

TAKEAWAY:

• Overall, 2.6% patients died in the hospital, 42.7% were discharged to home without HHC, 15.2% to HHC, 35.7% to a facility, and 1.2% left against medical advice.
• Among all the racial/ethnic groups, Hispanic patients with stroke had the highest rate of discharge to home without HHC (49%) and lowest hospital to facility discharge rate (29%) (P < .001).
• As opposed to White patients, Hispanic patients who had Medicare/Medicaid insurance and who were uninsured/self-paying, but not those who had private insurance, had lower odds of being discharged to a facility vs home after ischemic stroke (P < .001).

IN PRACTICE:

“Receiving the right care after a stroke is crucial to recovery and minimizing disability,” Shumei Man, MD, PhD, Cleveland Clinic, said in a press release. “Unfortunately, decisions about care may be influenced by factors such as race, insurance, and geographic location. Our study found a distinct pattern of disparities in care after stroke in the US for uninsured people, especially for uninsured Hispanic people, who had the lowest chance of receiving additional care after a stroke.”

SOURCE:

Shumei Man, MD, PhD, of the Cleveland Clinic, Cleveland, led the study, which was published online on July 17 in Neurology.

LIMITATIONS:

The study used ICD-10 codes that reflected claims billing, which could be affected by the incentives of maximizing reimbursement. Also, despite adjusting for several socioeconomic factors, comorbidities, and index stroke hospitalization information, there may be residual confounders and other social factors including the presence of other caregivers at home or marital/partnership status.

DISCLOSURES:

There was no targeted funding reported. Disclosures are noted in the original article.

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