Abstract 182: Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes with the United States General Population

Introduction Incarcerated individuals in state and federal prisons demonstrate disproportionately high rates of cardiovascular disease, especially hypertension and tobacco use. As a result, in comparison with the United States general population, inmates are faced with a more than three‐fold risk of acute ischemic stroke (AIS). Unfortunately, some evidence suggests that incarcerated individuals receive suboptimal medical care due structural barriers in healthcare delivery as well as discrimination based on incarcerated status. To our best knowledge, no studies to date have evaluated treatment rates and clinical outcomes of AIS in this specialized population. Methods Adult hospitalizations for AIS were identified in the 2015‐2020 National Inpatient Sample. Clinical variables, including incarcerated status, were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Rates of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) in addition to clinical outcomes (routine discharge back to institution/to home and in‐hospital mortality) were compared between incarcerated and non‐incarcerated individuals. Multivariable logistic regression (MVLRG) analysis controlling for age, race/ethnicity, baseline NIHSS score, stroke location, cardiovascular risk factors, and treatment modality was performed to determine the adjusted association of incarcerated status with the above clinical outcomes. Results Among 1,037,020 AIS hospitalizations, 460 (44.4/100,000) documented incarcerated status. Rates of EVT (6.5% vs. 6.7%, p=0.907) and IVT (19.6% vs. 18.1%, p=0.401) did not differ between incarcerated and non‐incarcerated individuals, respectively. Incarcerated individuals experienced higher rates of routine discharge disposition in comparison with non‐incarcerated individuals (75.0% vs. 36.6%, p<0.001), but mortality rates did not differ (2.2% vs. 3.5%, p=0.115). Following MVLRG analysis, incarcerated status was independently associated with routine discharge disposition (aOR 4.63, 95% CI 3.62, 5.92; p<0.001), but not with mortality (aOR 1.04, 95% CI 0.55, 1.97; p=0.906). Sensitivity testing in three separate sub‐group analyses of patients receiving acute reperfusion therapies (IVT and/or EVT), in strokes of the posterior circulation, and in high severity strokes (NIHSS>15) confirmed the findings of the primary analysis. Conclusion Incarcerated individuals with AIS are offered EVT and IVT at comparable rates to the general population and experience favorable clinical outcomes after accounting for age, stroke severity, and cardiovascular risk factors. Although these findings are encouraging, incarcerated individuals included in this study may represent a biased sample of those from particularly conscientious institutions and may not necessarily reflect the broader landscape of stroke care for this vulnerable population in the United States.