Abstract WP139: Racial Disparities in Acute Ischemic Stroke: Younger Age, Fewer Acute Stroke Treatments, and Higher Complications Among Black Patients in the United States

Introduction: Racial disparities in stroke care remain a major contributor to inequities in neurological outcomes. We aimed to evaluate demographic differences, vascular risk factors, acute stroke treatment patterns, and in-hospital outcomes between Black and White patients hospitalized with acute ischemic stroke (AIS). Methods: This was a large retrospective study using the 2022 National Inpatient Sample. All adult AIS patients were identified and grouped by race (White vs Black). Other races were excluded. Demographics, risk factors, presumed etiologies, acute treatments, and hospital outcomes were compared using survey-weighted analyses with rao-scott chi square and linear regression. Results: Among 689,596 AIS hospitalizations, 455,360 (66.0%) were White and 123,175 (17.9%) were Black. Black patients were significantly younger (median 65 vs 73, p<0.0001) and more likely to have stroke in the young (14.7 vs 6.8%). They had higher rates of hypertension (88.1 vs 82.6%), diabetes (48.0 vs 35.8%), smoking (23.1 vs 18.5%), and obesity (20.1 vs 16.0%), while white patients had higher rates of hyperlipidemia (60.7% vs 56.1%) (all p<0.0001).: Acute treatments differed significantly by race, as Black patients were 16% less likely to receive intravenous thrombolysis (8.7% vs. 10.3%) and 19% less likely to undergo thrombectomy (5.6% vs. 6.9%; both p<0.0001).: Despite being younger, Black patients experienced longer hospitalizations with an average length of stay 2.8 days longer than White patients (95% CI 2.6–3.1, p<0.001). They also had higher complication rates, including tracheostomy (2.9% vs. 1.1%), sepsis (10.2% vs. 8.6%), pneumonia (9.3% vs. 8.2%), and deep vein thrombosis (3.8% vs. 2.7%; all p<0.0001). In-hospital mortality was lower among Black patients (6.9% vs. 7.8%, p<0.0001), though the effect size was modest. Conclusions: In this large, nationally representative cohort, Black patients with AIS were less likely to receive acute reperfusion therapies and more likely to experience prolonged hospitalization and medical complications when compared with White patients with AIS. These findings are consistent with similar analyses done in years past, and highlight persistent racial inequities in stroke care and outcomes. Although progress has been made toward egalitarianism in stroke care, further efforts are still needed to achieve equitable use of acute stroke interventions and improve outcomes for Black patients.