Association Between Race and Length of Stay Among Stroke Patients: The National US Emergency Departments Data Set

Abstract

BACKGROUND There remain ongoing racial and ethnic disparities in care and outcomes among stroke patients treated in the United States. However, length of stay and inpatient charges warrant further evaluation. METHODS The 2019 Nationwide Emergency Department Sample, which includes data from roughly 20% of US emergency departments, was queried for patients with cerebral infarction. Multivariable logistic regression was used to estimate the odds of prolonged length of hospital stay (>75th percentile) and inpatient charges among various race andethnic groups, including income and insurance status, age, modified Charlson Comorbidity Index, vascular risk factors, and delivery of thrombolysis and thrombectomy. RESULTS Of 617 946 estimated patients with acute ischemic stroke, 398 661 (65.5%) were >65 years, and 386 096 (63.5%) were Medicare beneficiaries. Lower income and Medicaid or self‐pay status were more commonly observed in Black and Hispanic versus White patients ( P <0.001). In multivariable regression, Black patients were more likely to have a prolonged length of stay (odds ratio 1.41, [95% CI 1.28–1.55]) compared with White patients. Prolonged length of stay was inversely related to income, but there was no significant interaction between race and income bracket ( P >0.05). Prolonged length of stay was also associated with Medicaid (versus Medicare), higher modified Charlson Comorbidity Index, thrombolysis, and thrombectomy ( P <0.05). Race was not independently associated with higher inpatient charges. CONCLUSION These results build on prior population‐based studies that indicate ongoing disparities in stroke care based on differences in socioeconomic status and race, but no difference in inpatient charges. Disposition delays may be due to clinical severity or access to rehabilitation facilities.

Real-World Outcomes for Basilar Artery Occlusion Thrombectomy With Mild Deficits: The National Inpatient Sample

“…Patient comorbidities reported in this analysis included hypertension, diabetes, dyslipidemia, atrial fibrillation, overweight, coronary disease, tobacco use, and a modified Charlson Comorbidity Index (mCCI), as described previously. 9 Briefly, mCCI scores for each patient were calculated based on available ICD-10 diagnosis codes in the NIS, with diabetes and liver disease dichotomized as present or absent, and prior stroke or transient ischemic attack excluded from the index due to confounding with the admission diagnosis of stroke. As patient age was categorized based on the following cutoffs for young adults (21-44), adults (45-64), and elderly (≥65), age was incorporated into the mCCI as a categorical variable.…”

Patient factors associated with prolonged length of stay after traumatic brain injury

“…Interestingly, no association was found between Medicare or commercial insurance and LOS. Medicaid status has been shown to be associated with prolonged LOS in other medical and surgical conditions (Dallal et al 2007;Patel et al 2023). Medicaid, a joint program between the federal and state governments, was created to cover the costs of providing health care for patients with limited nancial means (Social Security Administration, 2009).…”