Gender, Racial, Ethnic, and Socioeconomic Disparities in Palliative Care Encounters in Ischemic Stroke Admissions

Muhammad Zia Khan, Salman Zahid, Asim Kichloo, Shakeel Jamal, Abdul Mannan Khan Minhas, Muhammad U. Khan, Waqas Ullah, Yasar Sattar, Sudarshan Balla

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: There is a scarcity of data on disparities in palliative care encounters in ischemic stroke patients. We have sought to answer these questions using the national inpatient database (NIS) data between 2002 and 2017. We aim to study gender, racial, regional, and socioeconomic disparities in palliative care encounters in ischemic stroke patients. Methods: We have analyzed the NIS data from January 2002 to December 2017 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM codes. Linear regression was used for trend analysis and multiple logistic regression was used for adjusted analysis. Results: A total of 9,542,169 discharge encounters with a diagnosis of ischemic stroke were recorded from 2002 to 2017. Out of these 412,394 (4.3%) had a palliative care (PC) encounter. The median age for patients with a PC encounter was 81 (Interquartile range [IQR 79–88]). PC encounters have shown a rapid increase over the years (from 0.5% in 2002 to 8.3% in 2017, p < 0.01). Adjusted multivariate analysis showed that African Americans (OR, 0.726 [95%CI, 0.716–0.736], p < 0.01), and Hispanics (OR, 0.738 [95%CI, 0.725–0.751]) were less likely to have a PC encounters. Females (OR, 1.18 7 [95% CI, 1.177–1.197], p < 0.01) were more likely to have PC encounters. Patients with better socio-economic status (OR, 1.034 [95%CI, 1.011–1.034], p < 0.01), having private insurance (OR, 1.562 [95%CI, 1.542–1.583], p < 0.01) and being in urban centers (OR, 1.815 [95%CI, 1.788–1.843], p < 0.01) were more likely to receive a PC encounter. Conclusions: Significant racial, ethnic and socioeconomic disparities exist in PC encounters in ischemic stroke patients. The underlying reasons for this need to be explored further.

Original languageEnglish
Pages (from-to)147-154
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume35
DOIs
StatePublished - Feb 2022

Keywords

  • Ischemic stroke
  • National inpatient sample
  • Palliative care encounters
  • Racial disparities
  • Socio-economic disparities

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