Black patients are 41% more likely than white patients to experience a prolonged length of stay after going to the hospital for acute ischemic stroke, according to a new study published in Stroke: Vascular and Interventional Neurology.[1]
The study analyzed data from more than 600,000 stroke patients of all races, drawing its information from the 2019 Nationwide Emergency Department Sample. Patient data represented roughly 20% of U.S. hospital emergency departments across 41 states.
For the purposes of the study, a “prolonged” inpatient stay was defined as one that fell in the 75th percentile or greater for included patients.
Socioeconomic status also plays a factor in length of stay, with patients in the lowest income quartile experiencing the longest mean length of stay and those in the highest income quartile experiencing the shortest. Black patients were more likely to be uninsured or Medicaid beneficiaries than white patients, and were also more likely to be in lower income brackets.
However, the 41% increased likelihood was calculated after adjusting for estimated income, region, insurance payor, comorbidities, and surrogates for stroke severity—such as thrombolysis, thrombectomy, trauma, and teaching center designation.
“One potential explanation for this disparity in hospitalization duration is that Black and other race or ethnic groups have more severe strokes than whites, with prolonged hospitalizations related to medical complications from stroke,” the study’s authors wrote.
Notably, 42% of Black patients were transferred directly into post-acute care facilities such as skilled nursing facilities or intermediate care facilities. A patient moving on to post-hospital care may be an indicator that their situation was complex and required more attention and resources from the beginning—but it also could be indicative of limited access or difficulty arranging follow-up care.
“Longer hospitalizations may be necessary for some patients with more severe neuromedical disease," the authors wrote. "However, prolonged hospitalizations may reflect access to rehabilitation and skilled nursing facilities.”
The researchers did not find significant differences in length of stay within different race or ethnicity groups with the same disposition.
Overall, the study’s findings from its large dataset offers more opportunities for follow-up to fully understand disparities in care delivery.