Racial and Rural Disparities in Stroke Discharge Disposition Stratified by 90-Day Survival Status.
Mengyuan Cheng, Winston Kennedy, Brady Post and 1 others
PMID 40885541WHAT IT FOUND
Black, Hispanic, and other-race stroke patients who died during hospitalization or within 90 days after discharge were less likely than non-Hispanic White patients to be discharged to hospice or other care.
Among longer survivors, no clear race or rurality differences appeared.
Key findings
01Among patients who died during hospitalization or within 90 days postdischarge, Black and Hispanic patients had lower odds of discharge to hospice or other institutional care settings compared with non-Hispanic White patients (OR 0.38, 95% CI 0.20-0.73), and other-race patients had similarly lower odds (OR 0.26, 95% CI 0.11-0.62).
02In the same dying subgroup, rural-adjacent patients had lower odds of discharge to hospice or other settings compared with urban residents (OR 0.56, 95% CI 0.31-1.01), and rural-nonadjacent patients had a similar non-significant trend (OR 0.64, 95% CI 0.33-1.25).
03Among patients who survived beyond 90 days, no statistically significant associations were found between discharge disposition and race or ethnicity or rurality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational and cannot show that race or rurality caused the discharge differences. 5809 patients were excluded for missing NIHSS scores, so the analytic sample may not represent all hospitalized stroke patients. It did not measure caregiver availability, social or family support, or hospital-level factors, which can influence discharge. The hospice/other category combines hospice, transfer to another hospital, and other settings, so hospice alone cannot be separated. The rural-adjacent confidence interval included 1.01, so that finding is not a clear difference. Data are from 2021 and may reflect pandemic-related disruptions, which were not isolated. Stroke severity was measured by the NIHSS, which may not fully capture functional status or cognitive impairment.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that race or rurality caused unfair discharge decisions or that changing discharge planning will remove these differences. This was an observational study without data on caregiver availability, family support, or hospital factors, and the rural-adjacent confidence interval included 1.01.