Racial and Socioeconomic Disparities in Ischemic Stroke Outcomes among Non-lytic/Thrombectomy Patients
Riya Bhavsar1, Tariq Nisar1, Alan Pan1, Amber Criswell1, Farhaan Vahidy2, David McCane3, Thao Dinh1, Ken Ling1, David Chiu1, Rajan Gadhia3
1Houston Methodist Hospital, 2Houston Methodist, 3Houston Methodist Hospital, WCMC
Objective:
Within a cohort of patients presenting with AIS (acute ischemic stroke) not receiving acute interventions (i.e. thrombolytics or thrombectomy), we analyzed racial and socioeconomic factors as predictors of good or poor functional outcomes.
Background:
Recent advances in stroke care have allowed for more inclusion of interventional and medical therapies for hyperacute ischemic stroke (AIS) presentation. However, there remains a subset of patients that do not qualify for acute interventions, and functional outcomes vary none-the-less.
Design/Methods:
Data was extracted from the HOPES (Houston Methodist Outcomes and Prospective Endpoints in Stroke) registry. Modified Rankin Score (mRS) at 90 days was classified into good (mRS 0-2) vs. poor (mRS 3-6) functional outcome. Socioeconomic disadvantage was derived from the area deprivation index (ADI) by geocoding patient addresses. Medians and interquartile range (IQR) are reported for continuous variables. Univariate and multivariate logistic regression models (adjusting for age, gender, race, ethnicity, and ADI) were constructed to calculate likelihoods of mRS 3-6. Odds ratio (OR) and 95% confidence intervals (CI) are reported.
Results:
Between 2016 and 2022, 4,030 patients were identified, of which 2,090 (51.9%) had good functional outcome at 90 days. Patients experiencing poor functional outcome were older (median age: 76 vs. 66 years; p<0.05). State-level ADI (median [IQR]: 5 [2-8] vs. 4 [2-7]) were higher in mRS 3-6. In adjusted models, African Americans (OR [CI]: 1.57 [1.33-1.86]) & Asians (OR [CI]: 2.00 [1.44-2.79]) were at higher odds of poor functional outcomes at 90 days (vs. Caucasians). Additionally, non-Hispanics had 32% lower risk of poor functional outcomes at 90 days (OR [CI]: 0.68 [0.55-0.84]).
Conclusions:
In this retrospective analysis of non-lytic/thrombectomy AIS patients, racial/socioeconomic disparities remain evident with higher odds of poor functional outcomes at 90-days. Our findings suggest a need to further characterize barriers to functional recovery in these patients.