Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke

Abstract

Background To inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications. Methods and Results A cohort of acutely hospitalized, first‐time non‐Hispanic White (NHW), non‐Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003–2012 and 2013–2022). Before matching, the final cohort consisted of 348 286 patients with first‐time stroke. Matching resulted in 63 722 non‐Hispanic Black–NHW pairs and 24 009 Hispanic–NHW pairs. Non‐Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54–0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62–0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70–0.74]) at 14 days. Hispanic–NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63–0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70–0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77–0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade. Conclusions There are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.

Keywords

• health care quality, access, and evaluation
• health inequities
• racial disparities
• stroke
• stroke rehabilitation