Socioeconomic Disparities in Acute Stroke Care at a Safety-net Hospital: A Retrospective Cohort Study
Ahmed Sabra1, Caryn Ha1, Kwame McCain1, Sraavya Anne1, Yaxel Levin-Carrion1, Jason Sherman1, Shakthi Rave1, Christina Banat1, Fadar Otite1, Erin Feinstein1, David Landzberg1
1Rutgers New Jersey Medical School
Objective:
To investigate differences in clinical characteristics, treatments and outcomes among acute ischemic stroke (AIS) patients with differing Socioeconomic status (SES) at a safety-net hospital (SNH).
Background:
SES is a well-established determinant of health, influencing access to care and outcomes. While disparities in AIS care based on SES have been reported, the impact of SES within SNHs remains unclear.
Design/Methods:
A retrospective analysis of emergency department stroke activations with a final diagnosis of AIS at a safety-net hospital was completed. Clinical, treatment, and outcome variables were collected through chart review. SES was estimated using Zipcode based median household income and adjusted for race. Low SES was defined as an upper limit of annual income twice the federal poverty level (≤$59,920). Patients were grouped into low vs medium and high SES and compared using univariate and multivariate analysis. The primary outcome was functional independence at discharge defined as a modified Rankin Scale score ≤2.
Results:
Among 363 AIS patients, 76% were low SES and 24% were moderate/high SES. Low SES patients were more likely to be African American (74% vs 47%, p<0.001) and less likely to be Hispanic (20% vs 31%, p=0.04). Median age, stroke severity, transportation method, and insurance status were similar across groups. Rates of intravenous thrombolysis (20% vs 21%) and mechanical thrombectomy (21% vs 24%) were comparable. Despite these similarities, low SES patients had higher rates of functional independence at discharge (39% vs 26%, p=0.04), and remained associated with greater odds of functional independence after adjusting for age and stroke severity (OR:1.87; 95% CI 1.04–3.34).
Conclusions:
Equitable delivery of AIS care was observed in the cohort; comparable rates of acute stroke therapies were received across groups. Patients with lower SES experienced better outcomes, highlighting the vital role of SNHs in ensuring high quality, accessible and equitable stroke care across socioeconomic and racial groups.
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