Persistent racial disparity in stroke hospitalization and economic impact in young adults in the buckle of stroke belt

Stroke. 2014 Jul;45(7):1932-8. doi: 10.1161/STROKEAHA.114.004853.


Background and purpose: Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina.

Methods: Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites.

Results: Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65 years) for both blacks and whites (P<0.001) but increased among the younger group (aged<65 years; P=0.004); however, this increase was mainly driven by a 17.3% rise among blacks (P=0.001), with no difference seen among whites (P=0.84). Of hospital charges totaling $2.77 billion, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients aged<65 years). Thirty-day stroke mortality rates decreased in all age-race-stroke-specific groups (P<0.001).

Conclusions: The stroke hospitalization rate increased in the young blacks only, which results in a severe and persistent racial disparity. It highlights the urgent need for a racial disparity reduction in the younger population to alleviate the healthcare burden.

Keywords: epidemiology; fees and charges; middle aged; minority health; stroke.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Black People / ethnology
  • Black People / statistics & numerical data*
  • Female
  • Healthcare Disparities / economics
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Hospital Mortality / ethnology
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / economics
  • Patient Discharge / statistics & numerical data
  • South Carolina / epidemiology
  • South Carolina / ethnology
  • Stroke / economics
  • Stroke / epidemiology*
  • Stroke / ethnology
  • Stroke / mortality
  • Time Factors
  • White People / ethnology
  • White People / statistics & numerical data*