Racial and ethnic disparities in stroke care(NOT RECOVERY!) in the United States vary by type of intervention and geographic location. Findings of this study were published in Stroke.

Previous studies have examined national disparities in stroke care(NOT RECOVERY!), but little is known about regional differences. Using the American Heart Association’s Get With the Guidelines-Stroke (GWTG-Stroke) registry, researchers assessed racial and ethnic disparities in stroke care(NOT RECOVERY!) at the national and state levels.

Eligible participants were admitted to GWTG-Stroke hospitals with acute ischemic stroke. The primary outcome was the percentage of patients receiving thrombolytics or endovascular thrombectomy (EVT) in each state. Thrombolytic eligibility was defined as last known well within 4.5 hours, National Institutes of Health Stroke Scale (NIHSS) score of 4 or more, and no contraindications. Endovascular thrombectomy eligibility was defined as last known well within 6 hours, NIHSS score of 4 or more, and large-vessel occlusion on imaging. In order to determine the relationship between treatment eligibility, functional outcome, and survival, the researchers also measured percent mortality, modified Rankin Scale score, and times to thrombolytics, groin puncture, or revascularization.

These data may inform future health care policy and allow for targeted regional and national efforts to address disparities in stroke care(NOT RECOVERY!) in the United States.

Between 2003 and 2022, a total of 4,856,450 patients were identified, of whom the mean (SD) age was 70.21 (14.48) years, 50.18% were women, and 45.56% were on Medicare. The majority (69.06%) of patients were non-Hispanic White, while 16.88% were non-Hispanic Black, and 7.02% were Hispanic. A total of 678,309 patients were eligible for thrombolysis, and 105,184 for EVT. Black and Hispanic patients had a significantly younger stroke onset than White patients. Black and Hispanic patients were also more likely to have Medicaid or be uninsured.  

At the national level, there was no meaningful disparity in thrombolytic administration between White and non-White patients after adjusting for covariates. Administration rates were significantly higher among Black (adjusted odds ratio [aOR], 1.04; 95% CI, 1.03-1.06), Asian (aOR, 1.12; 95% CI, 1.09-1.16), Hispanic (aOR, 1.14; 95% CI, 1.12-1.17), and other patients (aOR, 1.10; 95% CI, 1.07-1.13) compared with White patients (P <.0001 for all), suggesting a lack of racial disparity in thrombolytic-eligible patients.

In contrast, disparities were observed in states with the largest non-Hispanic Black populations, including New York, California, Texas, Virginia, Maryland, North Carolina, South Carolina, Georgia, Florida, and Alabama. In these states, many of which are in the stroke belt region of the US, non-Hispanic Black patients had up to 23% lower odds of receiving thrombolytics compared with non-Hispanic White patients.

Further, at the national level, non-Hispanic Black patients with stroke are significantly less likely to receive EVT compared with non-Hispanic White patients, even after adjusting for individual and hospital-level covariates. While unadjusted analyses suggest similar or higher EVT rates among non-White groups, adjusted models reveal a significant disparity only among non-Hispanic Black patients (aOR, 0.85; 95% CI, 0.82–0.89). This disparity is not explained by differences in treatment times and is geographically widespread, rather than concentrated in the stroke belt, contrasting with patterns seen in thrombolysis administration.

Researchers also observed variation in clinical outcomes across states for both thrombolysis and EVT. Non-Hispanic Black patients had lower odds of mortality following these treatments, but were also less likely to achieve good functional outcomes compared with non-Hispanic White patients. In some states, higher survival rates were associated with poorer functional recovery, while in others, disparities in functional outcomes existed without corresponding differences in mortality. They concluded, “These data may inform future health care policy and allow for targeted regional and national efforts to address disparities in stroke care(NOT RECOVERY!) in the United States.”

References:

Kim JA, Herman A, Shrader P, et al. National versus state-level racial disparities in acute stroke interventions using Get With The Guidelines-Stroke data. Stroke. Published online August 20, 2025. doi:10.1161/STROKEAHA.124.050446