Black Patients With Acute Ischemic Stroke Less Likely to Receive Endovascular Therapy

Shot of a senior man holding his chest in discomfort
Researchers assessed the utilization of endovascular therapy across racial and ethnic groups.

No evidence of ethnicity- or race-based disparity for access to endovascular therapy (EVT)-performing hospitals or comprehensive cardiovascular centers (CSCs) was observed among patients with acute ischemic stroke; however, fewer Black patients actually received EVT compared with other races or ethnicities. These findings were published in Stroke.

This retrospective population-based study assessed data from the Texas Inpatient Public Use Data File collected in 2019. Patients with acute ischemic stroke (n=40,814) were assessed for EVT utilization and outcomes on the basis of patient characteristics and center features. A nationwide dataset was obtained from the 2017 National Inpatient Sample (n=523,820) to confirm the findings from Texas.

Patients were 54% White, 21% Hispanic, and 17% Black. Compared with White patients, Black and Hispanic patients were younger, more likely to be uninsured, and to live in lower income neighborhoods. Black patients tended to present at centers in metropolitan areas and to have higher incidence rates of hypertension, heart failure, smoking, and substance use disorders. Hispanic patients had higher rates of diabetes and White patients had higher rates of atrial fibrillation.

In the multivariate analysis, EVT was associated with presenting at a CSC (adjusted relative risk [aRR], 6.04; 95% CI, 5.31-6.86; P <.001), atrial fibrillation (aRR, 2.52; 95% CI, 2.28-2.79; P <.001), heart failure (aRR, 1.29; 95% CI, 1.15-1.44; P <.001), obesity (aRR, 1.22; 95% CI, 1.08-1.38; P =.002), median household income of $56,000 to $73,999 (aRR, 0.87; 95% CI, 0.76-0.99; P =.042), dyslipidemia (aRR, 0.85; 95% CI, 0.77-0.93; P =.001), Black race (aRR, 0.76; 95% CI, 0.66-0.88; P <.001), diabetes (aRR, 0.73; 95% CI, 0.66-0.81; P <.001), and hypertension (aRR, 0.70; 95% CI, 0.62-0.79; P <.001).

The proportion of patients treated at all centers did not differ on the basis of race or ethnicity.

Stratified by center type, Hispanic patients were less likely to be admitted to an EVT-performing hospital in an urban area (RR, 0.93; 95% CI, 0.91-0.96) and more likely to be admitted in a rural area (RR, 1.11; 95% CI, 1.05-1.18). Black patients were less likely to be admitted to an EVT-performing hospital in a rural area (RR, 0.85; 95% CI, 0.78-0.93). For CSCs, Black patients were more likely to be admitted in an urban area (RR, 1.14; 95% CI, 1.10-1.17).

Among all hospital types Black patients were less likely to receive EVT (all P <.001) and Hispanic patients were less likely to receive EVT at EVT-performing non-CSC centers (P <.001) compared with White patients.

The nationwide data confirmed that Black patients were less likely to receive EVT (RR, 0.87; 95% CI, 0.77-0.98; P =.024).

This study was limited by not having access to patient information which may have been important for evaluating EVT eligibility.

This study found that patients with acute ischemic stroke in Texas had similar access to EVT-performing and CSC sites, but that Black patients were less likely to receive EVT. ”[W]e think that further study, focusing on smaller scales such as statewide or even more immediate cohorts, is important to better understand the source of these disparities,” the study authors wrote.


Kim Y, Sharrief A, Kwak MJ, et al. Underutilization of endovascular therapy in black patients with ischemic stroke: An analysis of state and nationwide cohorts. Stroke. Published January 24, 2022. doi:10.1161/STROKEAHA.121.035714