Impact of race on discharge location for stroke survivors: Associations with home discharge from a retrospective analysis.

Abstract

Background: White stroke survivors often experience better outcome compared to their counterparts. Poststroke discharge location influences the subsequent rehabilitation that can support recovery and improve outcomes. However, few studies have looked at the association of race and discharge to home.

Objective: To investigate the association between demographic and clinical characteristics of stroke survivors and their discharge location.

Design: Retrospective cohort.

Setting: Large, urban, academic medical center.

Patients: A total of 4633 stroke survivors admitted to the hospital with an acute onset diagnosis of ischemic stroke, hemorrhagic stroke, or transient ischemic attack between January 1, 2015 and April 30, 2023.

Interventions: Not applicable.

Main outcome measure: Discharge location as reported in the electronic health record. The Social Vulnerability Index was used to examine the association between social vulnerability and discharge location from the hospital.

Secondary outcome measure: Demographic and clinical characteristics of routine clinical care.

Results: The majority of participants were White (62.1%), followed by Black (21.6%). Most patients were discharged home from the hospital (58.5%). White patients had the highest percentage of transient ischemic attacks (24.4%), lowest scores on the National Institutes of Health Stroke Scale, (4.5), shortest lengths of stay (6.5 days), highest percentage of patients with no symptoms on the modified Rankin Scale (10.7%), and highest rates of home discharge (63.4%). Black stroke survivors had the highest rates of skilled nursing facility discharges (15.6%). Compared to White patients and patients of all other races, Black patients had a 27% lower odds of discharging home (odds ratio = 0.73, p = .001). Patients with higher levels of vulnerability in housing type and transportation had 35% lower odds of being discharged home compared to those with lower scores (odds ratio = 0.65, p = .002).

Conclusions: Racial differences in stroke outcomes and home discharge were observed between stroke survivors in this study, emphasizing the importance of addressing these disparities in order to promote equitable health care delivery and optimal outcomes.