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Was COVID-19 Associated With Worsening Inequities in Stroke Treatment and Outcomes?
Laurent G Glance1,2,3, Curtis G Benesch4, Karen E Joynt Maddox5,6
1Department of Anesthesiology and Perioperative Medicine University of Rochester School of Medicine Rochester NY.
Insights
The COVID-19 pandemic did not worsen stroke care disparities for Black and Hispanic patients. A national Medicare study found no evidence of exacerbated racial or ethnic disparities in stroke outcomes or treatment during high COVID-19 hospital burden periods.
Area of Science:
- Neurology
- Public Health
- Health Disparities
Background:
- The COVID-19 pandemic placed significant strain on hospital resources.
- Concerns were raised about potential disproportionate impacts on stroke outcomes and treatment for Black and Hispanic populations.
Purpose of the Study:
- To investigate whether the COVID-19 pandemic exacerbated existing disparities in stroke outcomes and reperfusion therapy rates.
- To analyze the impact of hospital COVID-19 burden on acute ischemic stroke care for different racial and ethnic groups.
Main Methods:
- Retrospective analysis of 100% Medicare data from 2016-2020.
- Interrupted time series analyses were employed to assess changes in stroke outcomes and treatment.
- Examined hospitalizations for acute ischemic stroke, comparing outcomes based on race/ethnicity and COVID-19 burden.
Main Results:
- Increased hospital COVID-19 burden (>30% of patients) correlated with a 51% rise in mortality odds and an 11% decrease in non-home discharges.
- Overall rates of motor deficits and reperfusion therapy did not significantly change with increasing COVID-19 burden.
- Black patients had lower 30-day mortality but higher motor deficits compared to White patients; Hispanic patients had lower mortality and similar motor deficits.
- No evidence of differential increases in adverse outcomes or reductions in reperfusion therapy for Black and Hispanic individuals as COVID-19 hospital burden rose.
Conclusions:
- This national study of Medicare beneficiaries found no evidence that increased hospital COVID-19 burden exacerbated disparities in treatment or outcomes for Black and Hispanic individuals with acute ischemic stroke.
- Findings suggest that existing racial and ethnic disparities in stroke care were not worsened by the pandemic's impact on hospital resources.
Abstract:
Background COVID-19 stressed hospitals and may have disproportionately affected the stroke outcomes and treatment of Black and Hispanic individuals. Methods and Results This retrospective study used 100% Medicare Provider Analysis and Review file data from between 2016 and 2020. We used interrupted time series analyses to examine whether the COVID-19 pandemic exacerbated disparities in stroke outcomes and reperfusion therapy. Among 1 142 560 hospitalizations for acute ischemic strokes, 90 912 (8.0%) were Hispanic individuals; 162 752 (14.2%) were non-Hispanic Black individuals; and 888 896 (77.8%) were non-Hispanic White individuals. The adjusted odds of mortality increased by 51% (adjusted odds ratio [aOR], 1.51 [95% CI, 1.34-1.69]; P<0.001), whereas the rates of nonhome discharges decreased by 11% (aOR, 0.89 [95% CI, 0.82-0.96]; P=0.003) for patients hospitalized during weeks when the hospital's proportion of patients with COVID-19 was >30%. The overall rates of motor deficits (P=0.25) did not increase, and the rates of reperfusion therapy did not decrease as the weekly COVID-19 burden increased. Black patients had lower 30-day mortality (aOR, 0.70 [95% CI, 0.69-0.72]; P<0.001) but higher rates of motor deficits (aOR, 1.14 [95% CI, 1.12-1.16]; P<0.001) than White individuals. Hispanic patients had lower 30-day mortality and similar rates of motor deficits compared with White individuals. There was no differential increase in adverse outcomes or reduction in reperfusion therapy among Black and Hispanic individuals compared with White individuals as the weekly COVID-19 burden increased. Conclusions This national study of Medicare patients found no evidence that the hospital COVID-19 burden exacerbated disparities in treatment and outcomes for Black and Hispanic individuals admitted with an acute ischemic stroke.
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