Abstract DP014: A National Evaluation of Racial, Ethnic, and Insurance-Based Disparities in Interhospital Transfer of Patients with Ischemic Stroke

Background: Disparities in interfacility transfer of patients with acute ischemic stroke (AIS) have been identified at the regional level, but a national analysis has not been conducted. This study aims to evaluate patient-level trends and disparities in transfer rates based on sex, race, ethnicity, and insurance status using the Get With The Guidelines (GWTG)-Stroke registry. Methods: The GWTG-Stroke registry was used to identify patients admitted with AIS between January 2016 through December 2021. IQVIA, Parsippany, NJ, is the data collection and coordination center. Data analyses were performed by the American Heart Association Precision Medicine Platform. We examined patient transfer rate by race/ethnicity groups and by patient insurance status. Odds of transferring out among each demographic group were calculated using multivariate linear regression analysis to account for patient and hospital level confounders. Models were stratified by sex to test for any potential interaction between sex with race/ethnicity or insurance status. Results: Among 776,556 transferred out of 1,333 sites, Hispanic and Black patients had lower odds of being transfer-out compared to non-Hispanic whites among both males and females after adjusted for stroke severity and hospital characteristics (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.74-0.84 for Hispanic females; and OR, 0.88; 95% CI, 0.83-0.93 for Hispanic males; and OR, 0.80; 95% CI, 0.76-0.83 for Black females; and OR, 0.84; 95% CI, 0.81-0.88 for Black males). Differences in transfer frequency were also noted based on insurance status. In the unadjusted model and model adjusted for stroke severity, patients of all payment groups had higher odds of being transfer out compared to Medicare patients. After also adjusting for hospital characteristics, patients with Medicaid had lower frequency of transfer compared to patients with Medicare among males and females (OR 0.75; 95% CI, 0.71 – 0.78 for females with Medicaid; and OR 0.78; 95% CI, 0.75 – 0.82 for males with Medicaid). Conclusion: In this large, nationwide cohort of patients with AIS, Black and Hispanic patients were less likely to be transferred than non-Hispanic White patients, and patients with Medicaid were less likely to be transferred than patients with Medicare. Further work is needed to understand contributors to this disparity and the impact on access to high quality stroke care.