Race and Income Disparity in Ischemic Stroke Care: Nationwide Inpatient Sample Database, 2002 to 2008

Background: Health care disparities exist between demographic groups with stroke. We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care. Methods: We studied all admissions for ischemic stroke in the Nationwide Inpatient Sample (NIS) database between 2002 and 2008. We used statistical models to determine whether median income or race were associated with intravenous (IV) thrombolysis treatment, in-hospital mortality, discharge disposition, hospital charges, and LOS in high- or low-volume hospitals. Results: There were a total of 477,474 patients with ischemic stroke: 10,781 (2.3%) received IV thrombolysis, and 380,400 (79.7%) were treated in high-volume hospitals. Race (P < .0001) and median income (P < .001) were significant predictors of receiving IV thrombolysis, and minorities and low-income patients were less likely to receive IV thrombolysis. Median income was a predictor of access to high-volume hospitals (P < .0001), with wealthier patients more likely to be treated in high-volume hospitals, which had lower mortality rates (P = .0002). Patients in high-volume hospitals were 1.84 times more likely to receive IV thrombolysis (P < .0001). Conclusions: African Americans, Hispanics, and low median income patients are less likely to receive IV thrombolysis for ischemic stroke. Low median income patients are less likely to be treated at high-volume hospitals. High-volume hospitals have lower mortality rates and a higher likelihood of treating patients with IV thrombolysis. There is evidence for an influence of socioeconomic status and racial disparity in the treatment of ischemic stroke.