Racial and Ethnic Disparities in Ischemic Stroke Severity in the National Inpatient Sample Between 2018 and 2021

BACKGROUND: The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States. METHODS: We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models. RESULTS: We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22–6.29), for Black patients was 7.12 (95% CI, 7.05–7.19), for Hispanic patients was 6.86 (95% CI, 6.76–6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18–7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings. CONCLUSIONS: In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.