Abstract 3626: Racial Differences and Insurance Status Influence Admission to Primary Stroke Centers among Patients with Acute Stroke
Background: Establishment of Primary Stroke Centers based on the Brain Attack Coalition’s criteria has become an important approach to improve quality of stroke care. Minorities, especially African Americans, have not only a high stroke incidence and mortality, but also have a higher representation in the Medicaid population, and limited access to health care. We assessed the hypothesis that racial and insurance differences exist in admission to New York State Designated Stroke Centers (NYSDSC).
Methods: Using the Statewide Planning and Research Cooperative System, we identified 23,247 acute stroke patients admitted from emergency rooms in New York State in 2006. Patient age, gender, race, diagnosis, comorbidities, health insurance, poverty level, distance to stroke centers, and level of stroke center penetration (proportion of stroke patients admitted to NYSDSC in hospital service areas) were examined by multiple logistic regression analysis to identify independent predictors of admission to NYSDSC.
Results: Overall, 17,059 (73%) patients were admitted to NYSDSC. After multivariate adjustment, African Americans [odds ratio (OR) 0.59, 95% confidence interval (CI) 0.53– 0.65, p<0.001] and other ethnicities (OR 0.83, CI 0.74 – 0.94, p=0.003) were associated with significantly lower likelihood of admission to designated stroke centers as compared to whites. Medicaid (OR 0.83, CI 0.71– 0.97, p=0.023) and Medicaid HMO patients (OR 0.76, CI 0.60 – 0.95, p=0.018) had significantly lower likelihood of admission to stroke centers than Medicare patients. Predictors of higher likelihood of admission to designated stroke centers included younger age, hemorrhagic stroke, congestive heart failure, valvular disease, and living in a high stroke center penetration area. Patients with psychosis and those living further away from a stroke center were less likely to be admitted to designated stroke centers.
Conclusion: Minorities and Medicaid patients were admitted significantly less often to New York State Designated Stroke Centers. The reasons for these disparities among traditionally underserved population are unclear. Further investigation is needed to identify the potential causes and evaluate the effect of disparities on patient outcomes.