Racial Differences in Outcomes after Acute Ischemic Stroke Hospitalization in the United States

Background and objectives: Racial differences in stroke outcomes have major health policy implications. There is paucity of contemporary data on racial differences in clinical outcomes and resource utilization in acute ischemic stroke hospitalizations in the United States. Methods: We used the 2011-2012 National Inpatient Sample to identify hospitalizations with a primary diagnosis of acute ischemic stroke. Primary outcomes were in-hospital mortality, utilization of thrombolysis, and endovascular mechanical thrombectomy (EMT). Secondary outcomes were length of stay (LOS) and average inflation-adjusted charges. Results: A total of 173,910 hospitalizations representing 835,811 hospitalizations nationwide were included in the study. Mean age was 70.9 years and 52.3% were women. Blacks (adjusted OR .71, 95% CI .64-.78, P < .001) and Asian or Pacific Islanders (adjusted OR .80, 95% CI .66-.97, P = .02) had a lower in-hospital mortality compared to Whites. Blacks were less likely to be treated with thrombolysis (adjusted OR .84, 95% CI .76-.92, P < .001) and EMT (OR .73, 95% CI .58-.91, P = .01). Average LOS and inflation-adjusted charges were significantly higher for racial minorities compared to Whites. Conclusions: Blacks and Asians hospitalized for ischemic stroke are less likely to die in the hospital compared to Whites. Hospitalization for stroke in Blacks is associated with lower rates of reperfusion therapy, longer lengths of stay, and higher costs compared to Whites.