Abstract TP70: Association Between Race And Length Of Stay Among Stroke Patients: The National U.S. Emergency Departments Dataset

Abstract

Background: There remain ongoing racial and ethnic disparities in care and outcomes among stroke patients treated in the US. However, length of stay (LOS) and inpatient costs warrant further evaluation. Methods: The 2019 Nationwide Emergency Department Sample (NEDS), 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 costs among various race/ethnic groups, including income and payor status, age, modified Charlson Comorbidity Index (mCCI), vascular risk factors, and treatment with thrombolysis and thrombectomy. Results: Of 617,946 estimated patients with acute ischemic stroke, 398,661 (65.5%) were > 65y, 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 LOS (Odds Ratio 1.41, 95% confidence interval 1.28-1.55) compared to Whites. Prolonged LOS was inversely related to income, but there was no significant interaction between race and income bracket (p>0.05). Prolonged LOS was also associated with Medicaid (versus Medicare), higher mCCI, thrombolysis, and thrombectomy (p<0.05). Race was not independently associated with higher inpatient costs. Conclusions: 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 cost.