Unravelling healthcare access disparities in stroke care: a comprehensive analysis of socio-economic and racial disparities impacting patient outcomes

Eryka Thelline Roxas; Sushmitha Priya Narra; Nigel Leon Martis; Rasha Konane Afthab; Anvit Nanavati; Naga Siva Naveen Chodisetti

doi:10.18203/2320-6012.ijrms20260596

Authors

Eryka Thelline Roxas Cebu Institute of Medicine, Cebu City, Cebu, Philippines
Sushmitha Priya Narra Pinnamaneni Sidhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India
Nigel Leon Martis Teaching University Geomedi, Tbilisi, Georgia
Rasha Konane Afthab Ivane Javakhishvilli Tbilisi State University, Tbilisi, Georgia
Anvit Nanavati Davao Medical School Foundation, Davao City, Davao Del Sur, Philippines
Naga Siva Naveen Chodisetti Cebu Institute of Medicine, Cebu City, Cebu, Philippines

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260596

Keywords:

Stroke, Socio-economic disparities, Health insurance, Racial disparities, Access to care, Equity in healthcare

Abstract

Background: Stroke is a primary cause of chronic disability in the United States (U. S.). The annual prevalence in 2022 is 84-262 per 100,000 people, with a 102% increase since 2021. This has led to a reduced quality of life index and increased depression rates, especially in the elderly population. Thus, the primary aim of our study was to determine any healthcare access disparities due to various socioeconomic and demographic factors, and the type of insurance companies used.

Methods: A retrospective observational study was conducted using the BRFSS (behavioral risk factor surveillance system) 2021 data. Descriptive and logistic regression analyses using the web enabled analysis tool (WEAT) were performed to assess various socioeconomic factors, demographic factors, and the type of insurance plans used.

Results: A total of 341,299 people were analyzed based on demographic and socioeconomic factors, and 403,145 people were analyzed based on access to healthcare and health status. Patients aged ≥65 years had the highest risk of developing stroke (4.97; p<0.0001). Individuals who were unable to work had the highest risk of stroke development (5.13; p<0.0001). Participants earning more than $200,000 had the lowest risk of stroke development (0.49; p<0.0001). Hispanic participants had the lowest risk of stroke (0.75; p<0.0016). Participants with Medicare insurance were most likely to develop stroke (4.77; p<0.0001).

Conclusions: Healthcare access disparities were noted based on various socioeconomic and demographic factors. Identifying these factors is important to minimize disparities, along with increasing affordability and accessibility to various stroke services, aiding in reducing its incidence.

Metrics

Metrics Loading ...

References

Barthels D, Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis. 2020;1866(4):165260. DOI: https://doi.org/10.1016/j.bbadis.2018.09.012

Liu Y, Wang H, Bai B. Trends in Unhealthy Lifestyle Factors among Adults with Stroke in the United States between 1999 and 2018. J Clin Med. 2023;12(3):1223. DOI: https://doi.org/10.3390/jcm12031223

Ikeme S, Kottenmeier E, Uzochukwu G, Brinjikji W. Evidence-Based Disparities in Stroke Care Metrics and Outcomes in the United States: A Systematic Review. Stroke. 2022;53(3):670-9. DOI: https://doi.org/10.1161/STROKEAHA.121.036263

Naveed H, Almasri M, Kazani B. Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes. Front Neurol. 2023;14:1147858. DOI: https://doi.org/10.3389/fneur.2023.1147858

Greenlund KJ, Denny CH, Mokdad AH, Watkins N, Croft JB, Mensah GA. Using behavioral risk factor surveillance data for heart disease and stroke prevention programs. Am J Prev Med. 2005;29(5-1):81-7. DOI: https://doi.org/10.1016/j.amepre.2005.07.007

Zhu C, Tran PM, Dreyer RP, Goldstein LB, Lichtman JH. Disparities in Internet Use Among US Stroke Survivors: Implications for Telerehabilitation During COVID-19 and beyond. Stroke. 2022;53(3):e90-1. DOI: https://doi.org/10.1161/STROKEAHA.121.037175

Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System (BRFSS). Available at: https://www.cdc.gov/brfss/index.html. Accessed on 25 April 2025.

U.S. Department of Health and Human Services. 2023. What is a stroke? National Heart Lung and Blood Institute. h Available at: ttps://www.nhlbi.nih.gov/health/stroke. Accessed on 25 April 2025.

Ziaeian, B, Xu H, Matsouaka RA, Xian Y, Khan Y, Schwamm LS, et al. US Surveillance of Acute Ischemic Stroke Patient Characteristics, Care Quality, and Outcomes for 2019. Stroke. 2022;53(11):3386-93. DOI: https://doi.org/10.1161/STROKEAHA.122.039098

Madsen TE, Khoury JC, Leppert M, Alwell K, Moomaw CJ, Sucharew H, et al. Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS. Stroke. 2020;51(4):1070-6. DOI: https://doi.org/10.1161/STROKEAHA.120.028910

Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn CJM, de Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019;92(21):e2444-54. DOI: https://doi.org/10.1212/WNL.0000000000007533

Błaż M, Banaszkiewicz K, Michalski M, Sarzyńska-Długosz I. Voluntary Unemployment Is Associated with Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults. J Occupat Environm Med. 2022;64(11):e672-6. DOI: https://doi.org/10.1097/JOM.0000000000002662

Nguyen RT, Khan SU, Valero-Elizondo J, Cainzos-Achirica M, Nasir K. Association of Income Status with Stroke in Non-Elderly Adults in the United States, 2012-2018. Curr Problems Cardiol. 2023;48(8):101235. DOI: https://doi.org/10.1016/j.cpcardiol.2022.101235

Ji Y, Du Z, Zheng K, Jiang Y, Ren C, Zhu H, et al. Bidirectional causal association between ischemic stroke and five mental disorders. Acta Psychiatrica Scandinavica. 2023;148(4):359-67. DOI: https://doi.org/10.1111/acps.13606

Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, et al. Emerging Risk Factors Collaboration. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA. 2020;324(23):2396-05. DOI: https://doi.org/10.1001/jama.2020.23068

Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2023 Update: A Report from the American Heart Association. Circulation. 2023;147(8):e93-21. DOI: https://doi.org/10.1161/CIR.0000000000001137

Khan SU, Khan MZ, Khan MU, Khan MS, Mamas MA, Rashid M, et al. Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017. Mayo Clinic proceedings. Innovat Qual Outcomes. 2021;5(2):431-41. DOI: https://doi.org/10.1016/j.mayocpiqo.2021.01.015