The aim of the study was to identify the management disparity of AIS amongst COVID-19 patients in adult USA hospitalizations.

Previous studies have shown a worrisome decline in stroke calls and reperfusion treatments during the COVID-19 pandemic, potentially affecting patient outcomes. However, the data on regional disparity in the management of AIS is very scarce.

A retrospective cross-sectional study was performed in adults with AIS hospitalizations using the nationwide inpatient sample(Jan-Dec 2020). AIS hospitalizations following COVID-19 and management given to patients were identified using ICD-10-CM. We performed univariate analysis using the chi-square test and mixed effects survey logistic regression with propensity-matched(1:3) for age and sex. Adjusted odds ratio(aOR) and 95%CI were obtained to identify management disparity keeping p<0.05 as significant. 

Out of 504,460 AIS hospitalizations, 7590(1.5%) patients identified with COVID-19. COVID-19 was prevalent higher in west (31.91% vs vs northeast:26.34% vs midwest:25.02% vs  vs south:22.69%),(p<0.0001, nCOVID-19=7590 vs nNon-COVID-19=22,770). Older population was predominant in midwest zone (66.46% vs west:60.83%), male in west (57.50% vs northeast:51.02%), female in northeast (48.98% vs west:42.50%), White in midwest (69.23% vs west:39.17), African American in northeast (28.57% vs west:9.17%), Hispanics in west (32.92% vs midwest:5.23%), Asians in west (7.92% vs south:1.06%), lower SES in south (43.10% vs south:43.10 %). Amongst COVID-19 patients, IV-tPA utilization was 39% lower in northeast (12.58% vs west:12.92%, aOR:0.61, 95%CI:0.53-0.69) and mechanical thrombectomy was 40% lower in northeast (8.50% vs west:9.58%, 0.60, 0.52-0.70), in compared to west. During COVID-19, overall IV-tPA utilization was increased by 11%(1.11, 1.03-1.20) and mechanical thrombectomy was increased by 29%(1.29, 1.17-1.41).