An observational analysis used data from the National Inpatient Sample (NIS) database between January 1st, 2018 and December 31st, 2020. All hospitalizations with ischemic stroke as the primary diagnosis were extracted using ICD-10 codes (I63.9). Demographics, comorbidities, hospital characteristics, and outcomes were analyzed and compared. IRB approval was exempt due to the study's retrospective nature. 

We analyzed 1,601,840 ischemic stroke admissions categorizing patients by insurance status: Medicare (64%), private insurance (24%), Medicaid (10%), and others (2%). Racial distribution varied, with fewer Black and Hispanic patients in the Medicare group compared to other insurance types. Multivariable logistic regression showed Medicare patients had a 23% lower risk of in-hospital mortality than those with private insurance (odds ratio: 0.77, [95% CI 0.72-0.83], p<0.001), while patients with other insurances faced a 65% higher risk (odds ratio: 1.65, [95% CI 1.43-1.91], p<0.001). Medicare and Medicaid patients also incurred higher total hospital charges than those with private insurance (p<0.001). Length of stay (LOS) was 0.097 days longer for Medicare patients (p<0.008) and 1.94 days longer for Medicaid patients, while other insurance types had a 0.34-day longer stay compared to private insurance (p<0.001).