A new study by researchers at the Naval Postgraduate School, the National Bureau of Economic Research, and the University of California, San Francisco, finds that residents in predominantly Black communities are more likely than those in predominantly White communities to live near a hospital with a certified stroke center. However, the study shows that when residents in these Black communities have a stroke, they are at greater risk of receiving care at a less-resourced hospital, where their chances of recovery are slimmer.
Researchers tracked patient demographics of general acute-care hospitals in the United States that offered stroke certification over a 10-year duration. Of the 4,984 hospitals, 961 were stroke certified in 2009, versus 1,763 in 2019. Stroke center certification ranges from primary stroke centers, which provide standard care, to comprehensive stroke centers that can treat the most complex cases. Treatment at stroke centers is associated with lower rates of mortality and severe disability.
The researchers found that residents of majority Black communities were 1.67 times more likely to live close to hospitals with specialty stroke centers, compared to residents of majority-White communities. However, when adjusting for population and hospital bed capacity, patients in majority Black communities were 26 percent less likely to receive care there.
“Black, racially segregated communities tended to cluster in areas with large populations, where stroke care must accommodate a much higher level of demand,” said Renee Hsia, of the department of emergency medicine at the Univerity of California, San Francisco and a co-author of the study. “Crowding may prevent patients from accessing the stroke center, and even if they do access it, they may not be able to be seen as quickly due to shortages of beds, critical care physicians, nurses, and equipment.”
The decision to open a new stroke center should take into account population size and underlying needs of the community that the center will serve, said Dr. Hsia. “Currently, the distribution of stroke care is more motivated by profit potential, rather than community need. We found that for many in low-income, minority, and rural communities, specialized stroke services are not even an option. Policymakers may want to consider how they can reduce financial barriers for hospitals in these communities where certified stroke centers are needed.”
The full study, “Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States,” was published on the website of the journal JAMA Neurology. It may be accessed here.
