Reducing Inequalities in Stroke Events-Hemorrhagic Disparities (RISE-HD): a 10-Year Longitudinal Study in Florida

Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are less common than ischemic strokes but carry higher mortality and disability. Despite declining mortality, disparities across racial, socioeconomic, and geographic groups persist.

We analyzed inpatient data from the Florida Agency for Health Care Administration (2013 - 2024). The primary outcome was in-hospital mortality. Associations with mortality were assessed for race/ethnicity, sex, insurance type, geographic region, and rural residence using multivariable logistic regression adjusted for the Elixhauser Comorbidity Index. Kaplan-Meier analysis was used to estimate time to in-hospital mortality.

Among 120,529 patients (mean [SD] age 67.9 [15.5] years; 48.4% female), 5,232 (4.5%) lived in rural areas, but only 426 (0.4%) received care at rural hospitals. Most patients were White non-Hispanic (57.7%) or Black non-Hispanic (17.5%). The largest shares came from Central (23,792 [20.6%]), Southeast (20,641 [17.9%]), and Southwest (18,823 [16.3%]) Florida. Annual admissions increased from 6,690 (5.6%) in 2013 to 14,407 (12.0%) in 2023, the last complete year of data, while 2024 data represent a partial reporting period. In-hospital mortality declined significantly (P < .001). Higher mortality was associated with Black race (OR, 1.13; 95% CI, 1.07-1.20); Medicaid (OR, 1.84; 95% CI, 1.71-1.97) and other insurance (OR, 1.86; 95% CI, 1.75-1.97); Northwest (OR, 1.12; 95% CI, 1.03-1.21) and South regions (OR, 1.21; 95% CI, 1.13-1.30), and rural residence (OR, 1.3; 95% CI, 1.19-1.41; all P < .01).

In-hospital mortality from hemorrhagic stroke mortality has declined, yet significant racial, geographic, and socioeconomic disparities persist. Black patients, those with Medicaid or other non-Medicare insurance, rural residents, and those in Northwest and South Florida face higher mortality. Targeted system-level strategies are needed to address these inequities.