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Structural racism is associated with poor outcomes following ischemic stroke, including higher mortality and decreased likelihood of discharge home, according to findings published in Stroke.
Researchers conducted a national, population-based analysis of Medicare beneficiaries 65 years of age and older from 2016 to 2019 to examine the relationship between structural racism and outcomes following acute ischemic stroke. The researchers assessed structural racism across several domains, including integration and segregation, residential housing, education, employment, and income. A standardized composite structural racism score was created, and multilevel logistic models were applied for statistical analysis.
Of 71,078,619 Medicare beneficiaries, 844,406 had an incident acute ischemic stroke during the study period. After adjusting for sex, age, location, and race, each standard deviation increase in the composite structural racism score was associated with a 16% (95% CI, 1.108-1.215; P <.0001) increase in odds of poststroke inpatient mortality and a 6.2% (95% CI, 1.044-1.081; P <.0001) increase in odds of 30-day mortality for Black and White patients. An inverse association was observed between increasing structural racism and the likelihood of discharge to home (OR, 0.963; 95% CI, 0.940-0.986; P =.002).
Significant interactions were identified between race and 30-day all-cause mortality (P =.035) and odds of discharge home (P =.023). Black patients had a 4.5% increased likelihood of 30-day mortality and a 5.8% decreased likelihood of being discharged home for each standard deviation increase in the composite structural racism score, while White individuals had a 6.5% increased likelihood of 30-day mortality and a 3.5% decreased likelihood of being discharged home.
Study limitations include a reliance on administrative and survey data sets.
“[W]hile structural racism is associated with negative outcomes, there are also societal inequities like income inequality that affect both Black and White individuals, making future research and policy initiatives tantamount in ensuring equitable health outcomes for all individuals,” the authors concluded.
