Abstract WMP63: Race/ethnicity And Ischemic Stroke Severity In The United States

Abstract

Background: Although prior research has investigated the association of race/ethnicity with stroke severity, the cohorts were not nationally representative or stroke severity was put into categories (i.e, mild to severe). Methods: We performed an analysis of adult hospital discharges in the National Inpatient Sample 2016-2019 with a primary diagnosis of ischemic stroke (I63*) and an admission NIH Stroke Scale (NIHSS). We treat NIHSS as an interval variable because the 43 levels (0-42) approximate an interval variable and prior simulations have demonstrated that it does not inflate the type I error. We fit linear regression models to NIHSS with the predictor or self-reported race/ethnicity (White, Black, Hispanic, other). Model 1 is unadjusted, model 2 is adjusted for age and sex, model 3 is further adjusted for atrial fibrillation, diabetes, congestive heart failure, and hypertension, and model 4 is further adjusted for income quartile by zip code and primary payor. Results: We included 138,680 stroke discharges with a mean NIHSS of 6.7±7.3. The cohort was 68.8% White, 17.2% Black, 8.0% Hispanic, and 6.0% other. In unadjusted analysis, White discharges have a significantly lower NIHSS than other race/ethnicity (Figure 1). After sequential adjustments, Black discharges consistently have the most severe stroke severity, which is ~1 NIHSS point higher than White discharges (p<0.001, Figure 1), although the difference is similar for Hispanic and other discharges. Conclusion: In a large, contemporary, and nationally representative sample of acute ischemic stroke patients, we show an association between non-White race/ethnicity and higher stroke severity. These results require further validation, but are concerning for a potentially underappreciated health disparity in ischemic stroke.