ISCHEMIC stroke transfer rates show racial, ethnic, and insurance-based disparities across a nationwide U.S. registry analysis.
A national evaluation of patients with acute ischemic stroke found that Black and Hispanic patients were less likely to be transferred between hospitals than non-Hispanic White patients, even after adjustment for stroke severity and hospital characteristics. The findings point to persistent inequities in interhospital transfer, a process that can influence access to specialized stroke care.
The analysis used the Get With The Guidelines-Stroke registry to examine patients admitted with acute ischemic stroke from January 2016 through December 2021. Across 1,333 participating sites, 776,556 patients were included in the transfer analysis. Investigators assessed transfer rates by race, ethnicity, sex, and insurance status, using multivariable models that accounted for patient and hospital factors.
Race And Ethnicity Shape Ischemic Stroke Transfer
After adjustment, Hispanic and Black patients had lower odds of being transferred out compared with non-Hispanic White patients among both males and females. Hispanic females had an odds ratio of 0.79, while Hispanic males had an odds ratio of 0.88. Black females had an odds ratio of 0.80, and Black males had an odds ratio of 0.84.
These differences persisted after accounting for stroke severity and hospital characteristics, suggesting that disparities in interhospital transfer were not explained solely by differences in clinical presentation or site-level factors. For clinicians, the findings raise important questions about how transfer decisions are made and whether systems of care are equitably connecting patients to higher-level stroke services.
Medicaid Patients Had Lower Transfer Frequency
Insurance status also appeared to influence transfer patterns. In unadjusted analyses and models adjusted for stroke severity, patients in non-Medicare payment groups generally had higher odds of being transferred than Medicare patients. However, after adjustment for hospital characteristics, Medicaid patients had a lower transfer frequency than Medicare patients among both males and females.
Females with Medicaid had an odds ratio of 0.75 compared with females with Medicare, while males with Medicaid had an odds ratio of 0.78. These findings suggest that hospital-level context may play a meaningful role in how insurance-based differences emerge in acute ischemic stroke transfer.
Further work is needed to identify the drivers of these disparities and determine how transfer patterns affect access to high-quality stroke care. For healthcare professionals, the study underscores the need to evaluate not only treatment delivery, but also the pathways that determine whether patients reach the hospitals best equipped to manage complex stroke care.
Reference
Turner AC et al. National Evaluation of Racial, Ethnic, and Insurance-Based Disparities in Interhospital Transfer of Patients With Ischemic Stroke. Stroke. 2026;doi:10.1161/STROKEAHA.125.054333.
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