Hsia Renee Y, Shen Yu-Chu
Department of Emergency Medicine, University of California, San Francisco.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
JAMA Netw Open. 2025 Jul 1;8(7):e2524027. doi: 10.1001/jamanetworkopen.2025.24027.
Despite improvements in access to stroke technology, it remains unclear whether Black and White patients with stroke experience similar benefits after a hospital becomes stroke certified and whether stroke center expansion has changed disparities between Black and White patients over time.
To examine the association of hospital stroke center certification with receipt of acute ischemic stroke treatments and health outcomes between Black and White patients with stroke.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study implemented a linear probability model with hospital fixed effects to evaluate changes in outcomes for Black and White patients, comparing outcomes before and after a hospital was certified as a stroke center (treatment group) relative to changes in outcomes at hospitals that did not acquire stroke certification (control group). Participants included patients with acute ischemic stroke who were covered by Medicare fee-for-service, who lived in urban communities, and who were admitted to hospitals between January 1, 2009, and December 31, 2019. Data were analyzed from September 1, 2024, to April 30, 2025.
Admission to a certified stroke center.
Probability of (1) receipt of thrombolytic therapy, (2) receipt of mechanical thrombectomy, and (3) being home at 90 days and (4) 1-year mortality.
Among 2 109 075 million admissions of patients with stroke included in the analysis, 15.3% were Black, 84.7% were White, 56.8% were female, 15.3% were 65 to 69 years of age, 16.4% were 70 to 74 years of age, 17.7% were 75 to 79 years of age, 18.8% were 80 to 84 years of age, and 31.9% were 85 years or older. Among White patients, the probability of receiving thrombolytic therapy increased by 1.70 (95% CI, 1.19-2.21) percentage points when a hospital became a primary stroke center (PSC) and 3.76 (95% CI, 2.89-4.62) percentage points when a hospital became a thrombectomy-capable or comprehensive stroke center (TSC or CSC), relative to White patients at non-stroke-certified hospitals. Among Black patients, the probability of receiving thrombolytic therapy did not change when admitted to a new PSC or a new TSC or CSC compared with Black patients at non-stroke-certified hospitals. For thrombectomy, a new TSC or CSC was associated with an increase of 3.74 (95% CI, 3.02-4.45) percentage points for White patients and 0.97 (95% CI, 0.03-1.90) for Black patients. No improvements in being home at 90 days or in 1-year mortality were observed.
In this cohort study, the likelihood of receiving stroke treatments increased for White but not Black patients within the same facility after the center was stroke certified as a PSC or a TSC or CSC. These within-hospital racial differences serve as sobering evidence that racial disparities in stroke care persist despite increased access to care.
尽管在获得中风治疗技术方面有所改善，但尚不清楚黑人和白人中风患者在医院获得中风认证后是否能获得相似的益处，以及随着时间的推移，中风中心的扩张是否改变了黑人和白人患者之间的差异。
研究医院中风中心认证与黑人和白人中风患者接受急性缺血性中风治疗及健康结局之间的关联。
设计、设置和参与者：这项队列研究采用了具有医院固定效应的线性概率模型，以评估黑人和白人患者结局的变化，将医院被认证为中风中心之前和之后的结局（治疗组）与未获得中风认证的医院的结局变化（对照组）进行比较。参与者包括医疗保险按服务收费覆盖的急性缺血性中风患者，他们居住在城市社区，于2009年1月1日至2019年12月31日期间入院。数据于2024年9月1日至2025年4月30日进行分析。
入住认证中风中心。
（1）接受溶栓治疗的概率、（2）接受机械取栓的概率、（3）90天时在家的概率以及（4）1年死亡率。
在纳入分析的2109075例中风患者入院病例中，15.3%为黑人，84.7%为白人，56.8%为女性，15.3%年龄在65至69岁之间，16.4%年龄在70至74岁之间，17.7%年龄在75至79岁之间，18.8%年龄在80至84岁之间，31.9%年龄在85岁及以上。在白人患者中，当医院成为初级中风中心（PSC）时，接受溶栓治疗的概率增加了1.70（95%置信区间，1.19 - 2.21）个百分点；当医院成为具备取栓能力或综合中风中心（TSC或CSC）时，接受溶栓治疗的概率增加了3.76（95%置信区间，2.89 - 4.62）个百分点，这是相对于未获得中风认证医院的白人患者而言。在黑人患者中，与未获得中风认证医院的黑人患者相比，入住新的PSC或新的TSC或CSC时接受溶栓治疗的概率没有变化。对于取栓治疗，新的TSC或CSC使白人患者接受取栓治疗的概率增加了3.74（95%置信区间，3.02 - 4.45）个百分点，而黑人患者增加了0.97（95%置信区间，0.03 - 1.90）个百分点。未观察到90天时在家概率或1年死亡率有改善。
在这项队列研究中，在中心被认证为PSC或TSC或CSC后，同一机构内白人患者接受中风治疗的可能性增加，而黑人患者没有。这些医院内部的种族差异清楚地表明，尽管获得治疗的机会增加，但中风护理中的种族差异仍然存在。
