ArticleJournal of the American Medical Directors Association2025
Racial and Rural Disparities in Stroke Discharge Disposition Stratified by 90-Day Survival Status.
Article in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
4 authors.
Funding
Abstract
objectivesTo examine racial and rural-urban disparities in discharge disposition following hospitalization for ischemic stroke, stratified by 90-day postdischarge survival status.
designRetrospective cross-sectional study using Medicare claims data. SETTING AND
participantsA nationally representative 5% sample of Medicare Fee-For-Service beneficiaries hospitalized with a primary diagnosis of ischemic stroke in 2021 (N = 6804); 18% identified as racial or ethnic minorities, and 19% resided in rural areas.
methodsData were drawn from the 2021 Inpatient Standard Analytical Files and Medicare Beneficiary Summary File. The primary outcome was discharge disposition, categorized as (1) home or home health care, (2) skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), or (3) hospice or other settings. Race or ethnicity and rurality were key independent variables, with rurality categorized using Rural-Urban Commuting Area (RUCA) codes. We stratified analyses by survival status (died during hospitalization or within 90 days vs survived beyond 90 days). Multinomial logistic regression models adjusted for demographic, clinical, and socioeconomic covariates.
resultsAmong all beneficiaries, 44.4% were discharged to home or home health care, 39.9% to SNF or IRF, 10.5% to hospice or another hospital, and 5.2% died during hospitalization. Among those who survived to discharge, 13.6% died within 90 days. Among these, Black and Hispanic patients had lower odds of discharge to hospice or other settings compared with White patients [odds ratio (OR) 0.38, 95% CI 0.20-0.73]. Patients residing in rural-adjacent areas had lower odds of discharge to hospice or other settings compared with urban counterparts (OR 0.56, 95% CI 0.31-1.01). No significant disparities were found among survivors. CONCLUSIONS AND IMPLICATIONS: Disparities in discharge disposition were concentrated among patients nearing end of life. These findings highlight gaps in hospice and institutional care access for rural and minority populations, underscoring the need for targeted policy and clinical interventions to promote equity in poststroke care transitions.
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