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Racial differences in hospital discharge disposition among stroke patients in Maryland
Ebere Onukwugha1, C Daniel Mullins
1University of Maryland, School of Pharmacy, Department of Pharmaceutical Health Services Research, Baltimore, MD 21201, USA. eonukwug@rx.umaryland.edu
Insights
Black patients hospitalized for stroke face worse outcomes, including higher mortality and less desirable discharge dispositions compared to white patients. These disparities persist even after accounting for other health and demographic factors.
Area of Science:
- Medical research
- Public health
- Health disparities
Background:
- Racial disparities in healthcare outcomes are a significant concern.
- Stroke is a leading cause of death and disability, with potential for differential impact across racial groups.
Purpose of the Study:
- To investigate racial differences in discharge disposition among patients hospitalized for stroke.
- To assess if Black patients experience less favorable outcomes post-stroke hospitalization compared to White patients.
Main Methods:
- Retrospective analysis of hospital discharge data from Maryland (2000-2003).
- Inclusion criteria: stroke as primary diagnosis, race identified as Black or White.
- Statistical analysis using partial proportional odds logit regression to evaluate the influence of race on discharge disposition.
Main Results:
- Black males had higher odds of less desirable discharge dispositions compared to White males (OR=1.66).
- Black females had increased odds of death (OR=1.14) and combined mortality or medical facility discharge (OR=1.38) versus White males.
- Discharge categories were ordered by desirability: home (1), medical facility (2), death (3).
Conclusions:
- Black patients face elevated mortality risk and less favorable discharge outcomes after stroke hospitalization.
- Findings align with previous research indicating lower survival rates for Black individuals.
- Results remain robust after adjusting for demographic and clinical confounding factors.
Objective:
The objective of this retrospective study was to assess the evidence for racial differences in discharge disposition among patients hospitalized for stroke.
Data:
Hospital discharge data from the Maryland Health Services Cost Review Commission were used in the analysis. The data covered the period from January 2000 to September 2003.
Study Design:
Discharge-disposition categories were ordered such that higher numbers corresponded to less desirable outcomes: 1 = discharge to home; 2 = discharge to any medical care facility; 3 = death. We analyzed the influence of black race on the discharge disposition by estimating a partial proportional odds logit regression model that included demographic and clinical covariates.
Data Extraction:
The study inclusion criteria were 1) stroke (ICD9 431-434; 436-438) as a primary admission diagnosis and 2) patient race identified as black or white. Patients discharged against medical advice were excluded. The sample contained 51,564 stroke hospitalizations.
Principal Findings:
Based on the relative odds ratios (OR; 95% confidence interval [CI]), black males were more likely to be discharged to higher ranked (i.e., less desirable) discharge categories (OR = 1.66; CI 1.55-1.77) compared to white males. Black females were more likely to die (OR = 1.14; CI 1.02-1.28) and more likely either to die or to be discharged to medical care (OR = 1.38; CI 1.24-1.54) compared to white males.
Conclusions:
Blacks are at greater mortality risk following stroke hospitalizations and face less desirable discharge dispositions if they survive. These results are consistent with prior reports of lower survival rates among blacks and are robust to adjustments for various confounding factors.
