ArticleCirculation. Cardiovascular quality and outcomes2023
Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach.
Article in Circulation. Cardiovascular quality and outcomes, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Hospital Socioeconomic Status and Acute Stroke Treatment in the United States.Cerebrovascular diseases (Basel, Switzerland) · 2026Article
- Racial and ethnic disparities in access to acute stroke capabilities in California: Association with rurality and telestroke access.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2026Article
- Incidence and risk factors for post-stroke delirium in the elderly: A national inpatient sample (NIS) analysis.PloS one · 2026Article
- Examining the Impact of Area Deprivation on Endovascular Stroke Therapy Access.Stroke (Hoboken, N.J.) · 2025Article
- Review
- Measuring hospital inpatient Procedure Access Inequality in the United States.Health affairs scholar · 2024Article
- Application of Community Detection Methods to Identify Emergency General Surgery-Specific Regional Networks.JAMA network open · 2024Article
- Provision of Stroke Care Services by Community Disadvantage Status in the US, 2009-2022.JAMA network open · 2024Article
- Article
- Reframing Our Approach to Disparities in Cardiac Arrest Outcomes: The Importance of Systems and Structures in Patient Outcomes.Journal of the American Heart Association · 2023Article
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Authors and funding
8 authors.
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Abstract
backgroundOur objectives were to determine whether there is an association between ischemic stroke patient insurance and likelihood of transfer overall and to a stroke center and whether hospital cluster modified the association between insurance and likelihood of stroke center transfer.
methodsThis retrospective network analysis of California data included every nonfederal hospital ischemic stroke admission from 2010 to 2017. Transfers from an emergency department to another hospital were categorized based on whether the patient was discharged from a stroke center (primary or comprehensive). We used logistic regression models to examine the relationship between insurance (private, Medicare, Medicaid, uninsured) and odds of (1) any transfer among patients initially presenting to nonstroke center hospital emergency departments and (2) transfer to a stroke center among transferred patients. We used a network clustering method to identify clusters of hospitals closely connected through transfers. Within each cluster, we quantified the difference between insurance groups with the highest and lowest proportion of transfers discharged from a stroke center.
resultsOf 332 995 total ischemic stroke encounters, 51% were female, 70% were ≥65 years, and 3.5% were transferred from the initial emergency department. Of 52 316 presenting to a nonstroke center, 3466 (7.1%) were transferred. Relative to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups (Medicare odds ratio, 0.24 [95% CI, 0.22-0.26] and 0.59 [95% CI, 0.50-0.71], Medicaid odds ratio, 0.26 [95% CI, 0.23-0.29] and odds ratio, 0.49 [95% CI, 0.38-0.62], uninsured odds ratio, 0.75 [95% CI, 0.63-0.89], and 0.72 [95% CI, 0.6-0.8], respectively). Among the 14 identified hospital clusters, insurance-based disparities in transfer varied and the lowest performing cluster (also the largest; n=2364 transfers) fully explained the insurance-based disparity in odds of stroke center transfer.
conclusionsUninsured patients had less stroke center access through transfer than patients with insurance. This difference was largely explained by patterns in 1 particular hospital cluster.
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