Cited by 99Acute Ischemic Stroke ManagementHealth disparities and outcomesEmergency and Acute Care Studies

Race and income disparity in ischemic stroke care: nationwide inpatient sample database, 2002 to 2008

Kimball, Matthew M., Neal, Dan, Waters, Michael F., Hoh, Brian L.·2014·Journal of Stroke and Cerebrovascular Diseases

Abstract

Background Health care disparities exist between demographic groups with stroke. We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care.Methods We studied all admissions for ischemic stroke in the Nationwide Inpatient Sample (NIS) database between 2002 and 2008. We used statistical models to determine whether median income or race were associated with intravenous (i.v.) thrombolysis treatment, in-hospital mortality, discharge disposition, hospital charges, and LOS in high- or low-volume hospitals.Results There were a total of 477,474 patients with ischemic stroke: 10,781 (2.3%) received i.v. thrombolysis, and 380,400 (79.7%) were treated in high-volume hospitals. Race (P < .0001) and median income (P < .001) were significant predictors of receiving i.v. thrombolysis, and minorities and low-income patients were less likely to receive i.v. thrombolysis. Median income was a predictor of access to high-volume hospitals (P < .0001), with wealthier patients more likely to be treated in high-volume hospitals, which had lower mortality rates (P = .0002). Patients in high-volume hospitals were 1.84 times more likely to receive i.v. thrombolysis (P < .0001).Conclusions African Americans, Hispanics, and low median income patients are less likely to receive i.v. thrombolysis for ischemic stroke. Low median income patients are less likely to be treated at high-volume hospitals. High-volume hospitals have lower mortality rates and a higher likelihood of treating patients with i.v. thrombolysis. There is evidence for an influence of socioeconomic status and racial disparity in the treatment of ischemic stroke.

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Crossref · 10.1016/j.jstrokecerebrovasdis.2012.06.004

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Authors
Kimball, M. M., Neal, D., Waters, M. F., & Hoh, B. L.
Affiliations
  • University of Florida Health (US)
  • University of Florida (US)
Venue
Journal of Stroke and Cerebrovascular Diseases
Publisher
Elsevier BV
Published
2014-01
Volume
23
Issue
1
Pages
17-24
ISSN
1052-3057 (ISSN-L)
OpenAlex
W2005341654
Cited by
99
References
34
Citations by year
2026: 1 · 2025: 10 · 2024: 10 · 2023: 3 · 2022: 12 · 2021: 9 · 2020: 7 · 2019: 12 · 2018: 2 · 2017: 9 · 2016: 5 · 2015: 9 · 2014: 4 · 2013: 5 · 2012: 1
FWCI
4.53
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Stroke and Cerebrovascular Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
ischemic stroke, racial disparities, income inequality, socioeconomic status, intravenous thrombolysis, high-volume centers, in-hospital mortality, discharge disposition, hospital charges, length of hospital stay, African Americans, Hispanic Americans, access to stroke care
MeSH terms
Aged, Aged, 80 and over, Brain Ischemia, Female, Hospitals, Humans, Income, Inpatients, Length of Stay, Male, Middle Aged, Minority Groups, Patients, Social Class, Socioeconomic Factors, United States, Thrombolytic Therapy, Databases, Factual, Treatment Outcome, Hospital Mortality, Hospital Charges, Stroke, International Classification of Diseases, Healthcare Disparities

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