Effects of System-Level Factors on Race/Ethnic Differences in In-Hospital Mortality after Acute Ischemic Stroke

Area of Science:

• Neurology
• Public Health
• Health Disparities

Background:

• Stroke remains a leading cause of death, disproportionately affecting Black individuals.
• Understanding recent trends in in-hospital mortality after acute ischemic stroke (AIS) across race/ethnicity and sex is crucial.
• Investigating system-level factors that may influence these disparities is essential.

Approach:

• Analysis of the National Inpatient Sample (2006-2017) for over 643,000 adult AIS cases.
• Assessment of in-hospital mortality by race/ethnicity, sex, and age.
• Logistic regression adjusted for sociodemographic, clinical, and hospital characteristics, including hospital patient demographics.

Key Points:

• Overall AIS in-hospital mortality declined from 5.0% (2006) to 2.9% (2017).
• Mortality odds reduction was most pronounced in White individuals (69%) and least in Black individuals (57%) between 2012-2017 and 2006-2011.
• Non-White patients, particularly Black and Hispanic individuals over 65, showed lower adjusted odds of mortality compared to White patients.
• Mortality differences were most significant in hospitals serving predominantly White patients.

Conclusions:

• AIS mortality has decreased across all racial/ethnic groups.
• Non-White AIS patients exhibited lower in-hospital mortality than White patients.
• The disparity in mortality was most pronounced in hospitals predominantly serving White patients, warranting further investigation into biological, sociocultural, and system-level factors.