Nationwide Analysis of Palliative Care Utilization Among Ischemic Stroke Hospitalizations

Background/Objectives: Palliative care (PC) is an integral component of ischemic stroke management, yet contemporary nationwide data on its utilization, recent utilization rates, and associated disparities are lacking. This study examined PC utilization rates, demographic disparities, and clinical factors associated with receipt of PC (PC) across ischemic stroke hospitalizations in the United States (US) from 2016 to 2022. Methods: This retrospective cross-sectional study used data extracted from the National Inpatient Sample (NIS) to identify adult hospitalizations primary for ischemic stroke, identified via validated International Classification of Disease—10th Clinical Modification (ICD-10-CM) codes. PC use was identified using the code Z51.5. Multivariable logistic regression was performed to identify factors independently associated with PC, adjusting for demographics, hospital characteristics, clinical severity (National Institutes of Health Stroke Scale [NIHSS] category, Charlson Comorbidity Index), complications, and receipt of thrombolysis/thrombectomy. Results: Among 4350,924 weighted ischemic stroke hospitalizations, 253,555 (5.83%) received PC, ranging from 5.34% in 2016 to 6.40% in 2022. Hospitalizations involving Black (adjusted odds ratio [aOR], 0.71; 95% CI, 0.69–0.74) and Hispanic (aOR, 0.73; 95% CI, 0.70–0.77) individuals had significantly lower odds of PC receipt compared with those involving White individuals. Lower-income quartiles, rural hospitals, and non-teaching hospitals were independently associated with reduced odds of PC receipt. Compared with NIHSS scores of 0–9, higher NIHSS scores demonstrated a graded association with PC use (NIHSS 20–29: aOR, 8.53; NIHSS 30–39: aOR, 12.22). Malignant neoplasm (aOR, 3.83), respiratory failure (aOR, 3.04), and cerebral edema (aOR, 2.82) showed clinically large statistically significant associations with PC. Receipt of reperfusion therapies were inversely associated with PC use (aOR, 0.85 for thrombolysis; aOR, 0.71 for thrombectomy). Conclusions: PC utilization among ischemic stroke hospitalizations remains low, with persistent racial/ethnic, socioeconomic, and institutional disparities. System-level interventions are needed to expand equitable PC access across all stages of ischemic stroke care, including patients who receive reperfusion therapies.