Racial and Socioeconomic Disparities in Palliative Care Utilization Among Patients with In-Hospital Mortality After...

Despite advances in mechanical thrombectomy (MT), in-hospital mortality remains approximately 10-15%. Palliative care (PC) improves end-of-life quality, yet limited research has been conducted on PC disparities specifically among patients with in-hospital mortality after MT. We examined racial and socioeconomic disparities in PC utilization among patients who died following MT for acute ischemic stroke.

This retrospective cohort study used the National Inpatient Sample (2016-2022). We included adults ≥ 18 years who underwent MT for acute ischemic stroke and died during hospitalization. Primary exposures were race/ethnicity and median household income quartile for patient ZIP code. The primary outcome was receipt of PC, identified by ICD-10-CM code Z51.5. Survey-weighted multivariable logistic regression adjusted for age, sex, insurance, income and calendar year.

Among 4495 patients who died after MT (weighted N ~ 22,000; mean age 72.5 years; 49.3% female), overall PC utilization was 63.5%. PC rates varied by race: white 66.8%, Black 51.9%, and Hispanic 55.1%. In adjusted analyses, Black patients (adjusted odds ratio [aOR] 0.59, 95% CI 0.48-0.74) and Hispanic patients (aOR 0.64, 95% CI 0.49-0.82) had significantly lower odds of receiving PC compared with white patients. Lower neighborhood income was associated with decreased PC utilization (Low vs. High income: aOR 0.82, 95% CI 0.70-0.95). In intersectional analyses, low-income Black/Hispanic patients had the lowest PC receipt (aOR 0.50, 95% CI 0.40-0.62). Results were robust in sensitivity analyses.

Among adults with in-hospital mortality after MT for acute ischemic stroke, Black and Hispanic race/ethnicity and residence in lower-income neighborhoods were independently associated with lower odds of receiving a palliative care encounter. These associations persisted across multiple sensitivity analyses and were most pronounced among low-income minoritized patients. The administrative nature of the data limits causal interpretation, but these findings support further investigation into modifiable contributors to inequitable palliative care access after stroke intervention.