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Stroke Center Certification and Within-Hospital Racial Disparities in Treatment.

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Stroke center certification improved treatment access for White patients but not Black patients, highlighting persistent racial disparities in stroke care despite technological advancements. This study underscores the need for equitable care improvements.

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Area of Science:

  • Neurology
  • Public Health
  • Health Services Research

Background:

  • Access to stroke technology has improved, but its impact on racial disparities in stroke care remains unclear.
  • It is unknown if stroke center certification benefits Black and White patients equally or if it has altered existing disparities over time.

Purpose of the Study:

  • To investigate the association between hospital stroke center certification and the receipt of acute ischemic stroke treatments.
  • To compare health outcomes for Black and White patients following stroke center certification.

Main Methods:

  • A cohort study using a linear probability model with hospital fixed effects analyzed Medicare fee-for-service patients with acute ischemic stroke (2009-2019).
  • Outcomes were compared before and after hospital stroke certification (treatment group) versus non-certified hospitals (control group).
  • Key outcomes included receipt of thrombolytic therapy, mechanical thrombectomy, discharge home at 90 days, and 1-year mortality.

Main Results:

  • White patients experienced increased probabilities of receiving thrombolytic therapy and mechanical thrombectomy after stroke center certification.
  • Black patients did not show similar increases in the receipt of these acute stroke treatments following certification.
  • No significant improvements were observed in discharge home at 90 days or 1-year mortality for either racial group.

Conclusions:

  • Stroke center certification led to increased utilization of stroke treatments for White patients but not for Black patients.
  • These findings demonstrate persistent racial disparities in stroke care within the same facilities, even after certification.
  • The study highlights that increased access to stroke technology has not eliminated racial inequities in acute stroke treatment.