Abstract
Abstract only Introduction: Historically, non-Hispanic black (NHB) and Hispanic stroke survivors have been discharged at a poorer functional level than non-Hispanic whites (NHW). The purpose of this study was to examine race and ethnic differences in rehabilitation prescription and participation at time of discharge (DC) and in modified Rankin Scale (mRS) at 30- and 90-days post-stroke. Methods: The Transitions of Stroke Care Disparities Study is designed to reduce disparities and optimize post-stroke care in hospital-to-home transitions. Survivors of ischemic stroke and intracerebral hemorrhage from a subset of 165 hospitals in the Florida Stroke Registry were included in the Get with the Guidelines-Stroke® (GWTG-S) database. Race and ethnicity, therapy prescription and participation, and mRS were extracted from GWTG-S, and by self-report at 30- and 90-days after DC. Race and ethnic differences were assessed in therapy prescription, participation, and mRS using binary logistic regression adjusted for age, sex, stroke severity (NIHSS), and DC walking ability. Results: In 1,129 stroke survivors (mean age 64y, 45% women, 55% NHW, 23% NHB, 22% Hispanic, 76% independent walkers at DC), 29% were prescribed inpatient and 50% outpatient rehabilitation at DC. Multivariable analysis showed NHW were significantly less likely to be prescribed inpatient therapy compared to NHB [OR 0.56, 95%CI (0.35-0.88)] or Hispanics [OR 0.50, 95%CI (0.31-0.80)]. Hispanic individuals [OR 1.69, 95%CI (1.20-2.38)] were significantly less likely to be prescribed outpatient therapy compared to NHW or NHB. No differences in therapy participation were seen between NHW and NHB [OR 1.16, 95%CI (0.69-1.97)] or Hispanics [OR 1.41, 95%CI (0.82-2.43)]. No differences in mRS were seen between NHW and NHB [30-days, OR 0.85, 95% CI (0.52-1.39); 90-days, OR 0.68, 95%CI (0.42-1.11)] or Hispanics [30-days, OR 0.63, 95% CI (0.37-1.10); 90-days, OR 0.61, 95%CI (0.36-1.03)]. Conclusions: Although there were significant race and ethnic differences in therapy prescription setting, no race and ethnic differences were seen in therapy participation or in mRS at either 30- or 90-days. Further research is warranted to examine race and ethnic differences in stroke recurrence and readmission rates.