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(Stroke. 2009;40:3096.)
© 2009 American Heart Association, Inc.

Original Contributions

Influence of Age on Racial Disparities in Stroke Admission Rates, Hospital Charges, and Outcomes in South Carolina

Wuwei Feng, MD, MS; Paul J. Nietert, PhD Robert J. Adams, MD, MS

From the Departments of Neurosciences (W.F.) and of Biostatistics, Bioinformatics, and Epidemiology (P.J.N.), and the South Carolina Center of Economic Excellence in Stroke, Department of Neuroscience (R.J.A.), Medical University of South Carolina, Charleston, SC.

Correspondence to Wuwei (Wayne) Feng, MD, MS, Harborview Office Tower, 19 Hagood Ave, MSC 805, Medical University of South Carolina, Charleston, SC 29425. E-mail feng{at}musc.edu

Background and Purpose— Racial disparities among US stroke patients have been well documented. However, the extent to which disparities in outcomes vary by age is unclear. This study’s goals were to examine the degree of racial disparities in South Carolina between African Americans (AAs) and Caucasian Americans (CAs) in stroke admission rates, hospital charges, and outcomes and to determine whether racial differences varied by age.

Methods— From the state hospital discharge database, admissions with a primary diagnosis of stroke discharged from 2002 to 2006 were identified. Age group–specific stroke admission rates, hospital charges, length of stay, intensive care unit utilization, medical complications, and discharge disposition (in-hospital death, discharged home, discharge to rehabilitation facility) were compared between AAs and CAs by multiple-linear or logistic-regression analysis.

Results— There were 58 272 stroke admissions during the 5-year period. Stroke admission rates were persistently higher for AAs in all age groups except those 85 years old. Hospital charges totaled $1.51 billion; 24.0% ($362.5 million) of this total was attributable to racial disparities, 70.8% ($256.5 million) of which stemmed from the 36.6% of patients <65 years old. Most of the acute outcomes were poorer for AAs compared with CAs across age groups.

Conclusions— Racial disparities in stroke admissions are more pronounced in younger age groups and result in significant economic consequences. Although AA stroke patients experienced generally worse acute outcomes than did CAs, these differences appear to be relatively consistent across age groups.

Key Words: stroke • fees and charges • outcome assessment (health care) • healthcare disparities • South Carolina