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Updated: May 21, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Racial and Ethnic Disparities in Ischemic Stroke Severity in the National Inpatient Sample Between 2018 and 2021
Mahmoud Fayed1, Teng J Peng1, Lesli E Skolarus2
1Department of Neurology, University of Florida, Gainesville (M.F., T.J.P.).
Background:
The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States.
Methods:
We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models.
Results:
We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22-6.29), for Black patients was 7.12 (95% CI, 7.05-7.19), for Hispanic patients was 6.86 (95% CI, 6.76-6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18-7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings.
Conclusions:
In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.
