Racial Disparities in Hospital Discharge Location for Mild Stroke Survivors: An Examination of Age, Race, and Disability

Research Objectives: (1) To investigate the demographic characteristics of mild stroke survivors and their association with discharge location. (2) To assess the presence of and factors contributing to racial disparities in discharge location among mild stroke survivors.

Design: Retrospective cohort study using electronic health records with a diagnosis of acute onset ischemic stroke, hemorrhagic stroke, or transient ischemic attack from January 1, 2015 through April 30, 2023.

Setting: Large academic hospital in an urban area.

Participants: A convenience sample of 2,953 mild stroke survivors (NIHSS 0-4) admitted to the hospital for acute onset ischemic stroke, hemorrhagic stroke, or transient ischemic attack between January 1, 2015 and April 30, 2023 with complete data.

Interventions: Not applicable

Main Outcome Measures: Logistic regression was used to analyze the relationship between demographic variables, clinical characteristics, the Social Vulnerability Index (SVI), and discharge location.

Results: The average age of mild stroke survivors was 69.82±15.51. Most patients had no significant disability on the mRS following their stroke (38.43%). Most mild stroke survivors were discharged home after their initial acute hospitalization (72.88%). The majority of patients were White (65.46%), followed by Black (19.40%). Black patients were significantly younger (p < 0.001) and demonstrated significantly more social vulnerability across all measures (p <.001) compared to White patients. Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p=0.001). Logistic regression showed that Black patients (β=-0.23, p=0.05) and patients living areas with high vulnerability in housing type and transportation (β=-0.37, p=0.03) were less likely to be discharged home.

Conclusions: Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts.

Author(s) Disclosures: All authors declare no disclosures.