Local Stroke Center May Be Off Limits to Patients in Black Neighborhoods

UCSF-Led Study Shows Race, Income, Location Play Role in Who Gets Optimal Treatment

By Suzanne Leigh

A black patient lies in a hospital bed while their loved one holds their hand

Residents in predominantly Black communities are more likely than those in predominantly white communities to live near a hospital with a certified stroke center. But a new study shows that when residents in these Black communities have a stroke, they are at greater risk of receiving care at a less-resourced hospital, where their chances of recovery are slimmer.

In their retrospective study, researchers led by corresponding author Renee Hsia, MD, MSc, of the Department of Emergency Medicine at UC San Francisco, tracked patient demographics of general acute-care hospitals in the United States that offered stroke certification over a 10-year duration. Of the 4,984 hospitals, 961 were stroke certified in 2009, versus 1,763 in 2019, the researchers reported in their study publishing in JAMA Neurology on June 27, 2022.

Stroke center certification ranges from primary stroke centers, which provide standard care, to comprehensive stroke centers that can treat the most complex cases. Treatment at stroke centers is associated with lower rates of mortality and severe disability, according to recent studies that point to features such as rapid triage, specialized neurosurgeons, advanced imaging facilities and swift access to thrombectomy, a surgery to remove a blood clot from inside an artery or vein.

The researchers found that residents of majority Black communities, which were served by 10% of the hospitals in the study, were 1.67 times more likely to live close to hospitals with specialty stroke centers, compared to residents of majority white communities. However, when adjusting for population and hospital bed capacity, these patients were 26% less likely to receive care there, the researchers stated.

Greater Demand for Stroke Care in Black Communities

“Black, racially segregated communities tended to cluster in areas with large populations, where stroke care must accommodate a much higher level of demand,” said Hsia, who is also a core faculty member at the UCSF Philip R. Lee Institute for Health Policy Studies. “Crowding may prevent patients from accessing the stroke center, and even if they do access it, they may not be able to be seen as quickly due to shortages of beds, critical care physicians, nurses and equipment.”

We found that for many in low-income, minority and rural communities, specialized stroke services are not even an option

Renee Hsia, MD, MSc

The researchers also found a significant disparity in access to stroke centers when they compared residents’ resource levels. Residents in predominantly high-income areas were 3.4 times more likely to live close to a hospital with a certified stroke center compared with residents in predominantly low-income areas. Similarly, patients in rural areas were markedly less likely to be served by hospitals with certified stroke centers than those living in urban areas.

The decision to open a new stroke center should take into account population size and underlying needs of the community that the center will serve, said Hsia. “Currently, the distribution of stroke care is more motivated by profit potential, rather than community need. We found that for many in low-income, minority and rural communities, specialized stroke services are not even an option. Policymakers may want to consider how they can reduce financial barriers for hospitals in these communities where certified stroke centers are needed.”

Co-Authors: Yu-Chu Shen, PhD, professor of economics at the Naval Postgraduate School and research associate at the National Bureau of Economic Research; and Nandita Sarkar, PhD, research analyst at the National Bureau of Economic Research.

Funding: The study was supported by the Pilot Project Award from the NBER Center for Aging and Health Research, funded by the National Institute on Aging (P30AG012810); as well as National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI (UL1 TR001872).