Racial disparities in stroke outcomes within a large telestroke network

Stroke care disparities related to race and ethnicity have been well-documented, with African American populations experiencing higher stroke incidence and receiving less timely treatments like intravenous tissue plasminogen activator (tPA). Telemedicine, particularly telestroke, has emerged as a potential solution to address geographic and racial disparities in acute stroke care, yet some studies have reported persistent racial differences in treatment. This retrospective study was conducted to analyze data from a telestroke network consisting of a hub hospital and 38 spoke centers in Pennsylvania.

Patients who had presented with acute ischemic stroke and required a virtual consult with a neurovascular specialist were included in the study. The data collected from electronic medical records included baseline characteristics, stroke-related variables, treatment details, and outcomes. Descriptive statistics, chi-square tests, and a Kruskal-Wallis test were used to analyze the data. In addition, univariate and multivariable logistic regression analyses were performed to evaluate the association between race and key outcomes.

A total of 4256 patients were included, of whom 2925 were White and 1122 were African American. On multivariable logistic regression, African American patients, as compared to White patients, were less likely to undergo mechanical thrombectomy (OR 0.58, 95% CI 0.35-0.96, p = 0.03) and were more likely to be discharged to rehabilitation (OR 1.39, 95% CI 1.06-1.84, p = 0.01), with no significant differences in tPA administration or death between the two racial groups.

The study results suggest that African American patients are significantly less likely to undergo mechanical thrombectomy and more likely to be discharged to rehabilitation compared with their White counterparts, despite similar rates of tPA administration and death. These findings highlight persistent disparities in advanced stroke interventions and postacute care, emphasizing the need to address structural and socioeconomic barriers to ensure equitable treatment and recovery for all patients.