Abstract WMP91: Disparities in Inpatient Mortality from Acute Stroke: Near-national Estimates for Hispanics

Abstract

Background: Hispanics are the largest minority in the US, yet there is little national data describing stroke outcomes among Hispanic patients. Objective: To measure inpatient mortality following admission for ischemic stroke (IS), hemorrhagic stroke (HS), and subarachnoid hemorrhage (SAH) among non-Hispanic blacks, non-Hispanic whites, and Hispanics. Methods: We combined discharge data (2010-11) from universe of admissions at all non-federal hospitals from 15 states that account for 85% of the Hispanic population and had near-complete reporting of race/ethnicity (AZ, CA, CO, FL, IL, MA, MD, NJ, NM, NV, NY, OR, PA, TX, VA). We identified all hospitalizations for IS, HS, and SAH, and estimated logistic and hospital-level hierarchical logistic regression models to obtain rates of inpatient mortality by race/ethnicity adjusted for patient characteristics (age, sex, race/ethnicity, comorbidities) and hospital characteristics (annual hospital stroke volume). Results: We found 567,498 discharges for acute stroke; Hispanics accounted for 11.7%, blacks for 15.6% and whites for 68.7%. Among all discharges, IS accounted for 83%, HS 12% and SAH 5%. Compared to whites, Hispanics and blacks were younger and had lower observed mortality rate for all stroke subtypes (IS: whites 5.2%, blacks 3.3%, Hispanics 4.3%, p<0.001; HS: whites 25.7%, blacks 20.8%, Hispanics 21.3%, p<0.001; and SAH: whites 20.2%, blacks 17.5%, Hispanics 19.3%, p<0.001). In the fully adjusted model, compared to whites, Hispanic inpatient mortality was lower for HS but nor for IS or SAH (Table); in contrast, blacks had lower inpatient mortality for IS and HS (Table). Individual states’ overall adjusted stroke mortality for all subgroups combined was not significantly different for Hispanics, with the exception of CA (OR 0.90, 95% CI 0.85-0.96). Conclusion: In a near-national sample, Hispanic patients had lower adjusted inpatient mortality rates than whites for HS, and similar rates for IS and SAH.