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Racial disparities in carotid revascularization following stroke in minority-serving hospitals

Year: 2025

Type: article

Abstract: BACKGROUND: Beyond patient factors, recent evidence has suggested that institutional characteristics may contribute to persistent racial disparities in carotid revascularization following acute ischemic stroke. Minority-serving hospitals (MSHs) care for a disproportionately high number of historically underserved populations and thus may contribute to observed disparities. METHODS: All adults (≥18 years) admitted for acute ischemic stroke owing to carotid artery stenosis were identified in the 2016-2021 Nationwide Inpatient Sample. Patients with missing key data, elective status, or admitted to hospitals performing five or fewer carotid revascularization procedures per year (≤5th percentile) were excluded. Carotid revascularization composed of endarterectomy or stenting. The outcomes of interest were receipt of carotid revascularization, in-hospital mortality, myocardial infarction (MI), and a composite of both measures (death/MI), along with postoperative length of stay, hospitalization costs, and nonhome discharge. Multivariable regression models were developed to evaluate the association of MSH with outcomes of interest. RESULTS: <0.01), over the study period. After risk adjustment, treatment at MSH was associated with a significantly lower odds of receiving revascularization (AOR, 0.80; 95% CI, 0.74-0.87), relative to others. MSH status was linked with similar in-hospital mortality (AOR, 1.15; 95% CI, 0.96-1.22), but increased odds of MI (AOR, 1.17; 95% CI, 1.02-1.34) and death/MI (AOR, 1.14; 95% CI, 1.04-1.25). Treatment at these centers was associated with prolonged LOS (β +0.45 days; 95% CI, 0.14-0.76) and hospitalization expenditures (β +$5800; 95% CI, 4510-7080), along with increased relative risk of nonhome discharge (AOR, 1.10; 95% CI, 1.05-1.18) compared with non-MSH. Despite decreased revascularization use for Black and Asian patients across all centers, Hispanic race was linked with lower odds of revascularization solely at MSH. CONCLUSIONS: Providing increased resources to support MSH may be an effective strategy to ensure equal health access to racial/ethnic minority patients. Future studies incorporating hospital quality initiatives targeted for MSH are warranted.

Source: Journal of Vascular Surgery

DOI: 10.1016/j.jvs.2025.09.044