Abstract Details

Title Race/ethnicity and Insurance Status Impact Acute Ischemic Stroke Treatment within Three Large U.S. States

Topic Health Care Disparities

Presentation(s) S18 - Health Care Disparities (4:08 PM-4:16 PM)

Poster/Presentation
Number 002

Objective To determine whether race/ethnicity impacts rates of acute ischemic stroke treatment in state-level data.

Background Nationwide studies of thrombolysis and endovascular therapy (EVT) utilization for acute ischemic stroke demonstrate racial/ethnic disparities. We investigate whether disparities persist in statewide data.

Design/Methods We performed a retrospective analysis of adult hospitalizations for acute ischemic stroke (ICD-9-CM 434.X) in administrative claims data from California (2006-2011), Florida (2006-2014), and New York (2006-2014). We tested for an association between race/ethnicity, classified as White, Black, Hispanic, or other, and our outcomes of interest, treatment with thrombolysis and EVT, using multivariable logistic regression models. We adjusted for age, sex, significant comorbidities, markers of stroke severity, insurance status, and the interaction between race and insurance status.

Results Of the 1,051,522 included hospitalizations, 2,193 (0.2%) involved both thrombolysis and EVT, 39,959 (3.8%) thrombolysis alone, and 2,624 (0.2%) EVT alone. In multivariable analyses, Black (OR=0.65, p < 0.001) and Hispanic (OR=0.73, p < 0.001) race/ethnicity in California and Black race in Florida (OR=0.82, p < 0.001) were associated with lower thrombolysis rates compared to White race. Black (OR=0.69, p < 0.01) and Hispanic (OR=0.65, p < 0.01) race/ethnicity in New York were associated with lower rates of EVT compared to White race. Use of Medicare/Medicaid was associated with lower rates of thrombolysis and EVT in all states, while uninsured status predicted lower rates of thrombolysis and EVT in Florida only.

Conclusions Racial disparities in thrombolysis and EVT rates were not consistent across the three studied states. Low insurance status patients are less likely to receive interventions in all states, irrespective of race. Work to address racial/ethnic disparities in acute stroke treatment should target state-level disparities and policy in addition to broader improvements in access for patients on Medicare or Medicaid.

Authors/Disclosures
Alison Herman PRESENTER	Ms. Herman has nothing to disclose.
Lindsey R. Kuohn, MD	Dr. Kuohn has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Richa Sharma, MD (Massachusetts General Hospital, Brigham, Harvard)	Dr. Sharma has received research support from NIH. Dr. Sharma has received intellectual property interests from a discovery or technology relating to health care.
David Y. Hwang, MD, FAAN (University of North Carolina School of Medicine)	The institution of Dr. Hwang has received research support from NIH. The institution of Dr. Hwang has received research support from Neurocritical Care Foundation. Dr. Hwang has received publishing royalties from a publication relating to health care. Dr. Hwang has received personal compensation in the range of $10,000-$49,999 for serving as a Associate Medical Director with New England Donor Services.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.

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