Work

Racial and Rural Disparities in Stroke Discharge Disposition Stratified by 90-Day Survival Status

Year: 2025

Type: article

Abstract: OBJECTIVES: To examine racial and rural-urban disparities in discharge disposition following hospitalization for ischemic stroke, stratified by 90-day postdischarge survival status. DESIGN: Retrospective cross-sectional study using Medicare claims data. SETTING AND PARTICIPANTS: A nationally representative 5% sample of Medicare Fee-For-Service beneficiaries hospitalized with a primary diagnosis of ischemic stroke in 2021 (N = 6804); 18% identified as racial or ethnic minorities, and 19% resided in rural areas. METHODS: Data were drawn from the 2021 Inpatient Standard Analytical Files and Medicare Beneficiary Summary File. The primary outcome was discharge disposition, categorized as (1) home or home health care, (2) skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), or (3) hospice or other settings. Race or ethnicity and rurality were key independent variables, with rurality categorized using Rural-Urban Commuting Area (RUCA) codes. We stratified analyses by survival status (died during hospitalization or within 90 days vs survived beyond 90 days). Multinomial logistic regression models adjusted for demographic, clinical, and socioeconomic covariates. RESULTS: Among all beneficiaries, 44.4% were discharged to home or home health care, 39.9% to SNF or IRF, 10.5% to hospice or another hospital, and 5.2% died during hospitalization. Among those who survived to discharge, 13.6% died within 90 days. Among these, Black and Hispanic patients had lower odds of discharge to hospice or other settings compared with White patients [odds ratio (OR) 0.38, 95% CI 0.20-0.73]. Patients residing in rural-adjacent areas had lower odds of discharge to hospice or other settings compared with urban counterparts (OR 0.56, 95% CI 0.31-1.01). No significant disparities were found among survivors. CONCLUSIONS AND IMPLICATIONS: Disparities in discharge disposition were concentrated among patients nearing end of life. These findings highlight gaps in hospice and institutional care access for rural and minority populations, underscoring the need for targeted policy and clinical interventions to promote equity in poststroke care transitions.

Source: Journal of the American Medical Directors Association

DOI: 10.1016/j.jamda.2025.105847

Authors: Mengyuan Cheng, Winston Kennedy, Brady Post, Nasim Ferdows

Institution: Northeastern University

Language: English

Topic: Acute Ischemic Stroke Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $4,370