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Ischemic stroke
Original research
Racial disparities in functional outcomes following mechanical thrombectomy in a cohort of patients with ischemic stroke
  1. Tara Srinivas1,
  2. Kathleen Ran1,
  3. Sumil K Nair1,
  4. Alice Hung1,
  5. Christopher C Young1,
  6. Rafael J Tamargo1,
  7. Judy Huang1,
  8. Elizabeth Marsh1,
  9. Argye Hillis2,
  10. Vivek Yedavalli3,
  11. Victor Urrutia2,
  12. Philippe Gailloud4,
  13. Justin M Caplan1,
  14. L Fernando Gonzalez1,
  15. Risheng Xu1
  1. 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
  4. 4Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Risheng Xu, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; rxu4{at}jhmi.edu

Abstract

Background Non-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following mechanical thrombectomy.

Objective To describe patient characteristics, evaluate stroke risk factors, and analyze the adjusted impact of race on long-term functional outcomes to better identify and limit sources of disparity in post-stroke care.

Methods We retrospectively reviewed 326 patients with ischemic stroke who underwent thrombectomy at two centers between 2019 and 2022. Race was self-reported as NHB, NHW, or non-Hispanic Other. Stroke risk factors, insurance status, procedural parameters, and post-stroke functional outcomes were collected. Good outcomes were defined as modified Rankin Scale score ≤2 and/or discharge disposition to home/self-care. To assess the impact of race on outcomes at 3-, 6-, and 12-months’ follow-up, we performed univariate and multivariate logistic regression.

Results Patients self-identified as NHB (42%), NHW (53%), or Other (5%). 177 (54.3%) patients were female; the median (IQR) age was 67.5 (59–77) years. The median (IQR) National Institutes of Health Stroke Scale score was 15 (10–20). On univariate analysis, NHB patients were more likely to have poor short- and long-term functional outcomes, which persisted on multivariate analysis as significant at 3 and 6 months but not at 12 months (3 months: OR=2.115, P=0.04; 6 months: OR=2.423, P=0.048; 12 months: OR=2.187, P=0.15). NHB patients were also more likely to be discharged to rehabilitation or hospice/death than NHW patients after adjusting for confounders (OR=1.940, P=0.04).

Conclusions NHB patients undergoing thrombectomy for ischemic stroke experience worse 3- and 6-month functional outcomes than NHW patients after adjusting for confounders. Interestingly, this disparity was not detected at 12 months. Future research should focus on identifying social determinants in the short-term post-stroke recovery period to improve parity in stroke care.

  • thrombectomy
  • intervention
  • stroke

Data availability statement

Data are available upon reasonable request.

http://dx.doi.org/10.1136/jnis-2023-020634

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @vsyedavalli, @fegomd

    • Contributors TS and RX designed the study, monitored the data collection, and revised the paper. TS is the guarantor. TS collected the data from the online registry, analyzed the data, and drafted and revised the paper. KR and SKN collected part of the data from the online registry. AHu, CCY, RJT, JH, EM, AHi, VY, VU, PG, JMC, LFG, and RX contributed to clinical data collection. All authors critically reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.