Abstract 12195: Racial and Ethnic Disparities in Reperfusion Interventions and Stroke Center Care in California

Abstract

Background: There is significant hospital-level variation in quality of acute stroke care delivery. As a result, patients’ access to disability-reducing reperfusion interventions and stroke center care depends on the initial hospital of presentation and interhospital transfer. Our objective was to examine racial and ethnic disparities in access to reperfusion interventions, and whether interhospital patient transfer mitigates disparities in access to stroke center care. Methods: Using statewide administrating data including all emergency department and hospital discharges in California from 2010-2017, we identified acute ischemic stroke patients and outcomes of interest: thrombolytic therapy, endovascular thrombectomy (EVT) receipt, interhospital transfer, and discharge from primary or comprehensive stroke center hospital. We used hierarchical logistic regression modeling to identify the relationship between race/ethnicity and outcomes after accounting for important patient- and hospital-level factors. Results: Of 336,247 ischemic stroke patient encounters during the study period, 186,444 (55.4%) were non-Hispanic white, 66,016 (19.6%) Hispanic, 34,596 (10.3%) non-Hispanic Black and 35,784 (10.6%) non-Hispanic Asian/Pacific Islander. Relative to non-Hispanic white patients, adjusted odds of thrombolytic receipt were lower for Hispanic, non-Hispanic Asian/Pacific Islander, and non-Hispanic Black patients (Figure). Adjusted odds of EVT were lower for Hispanic and non-Hispanic Black patients. Adjusted odds of interhospital transfer were lower among Hispanic and non-Hispanic Asian patients. Adjusted odds of discharge from a stroke center hospital was similar across racial/ethnic groups. Conclusions: There are racial/ethnic disparities in receipt of reperfusion interventions among stroke patients in California. Configuration of the stroke system of care, hospital resources, and transfer patterns may contribute.