ScholarWorks@성균관대학교

초록

Background Socioeconomic disparities persist in acute ischemic stroke care despite advances in early recognition and intervention.Aims This study evaluated the associations between ZIP code-based income levels, demographic factors, and clinical outcomes in ischemic stroke using a large, contemporary national dataset from the United States.Methods We analyzed adult hospitalizations with a primary diagnosis of ischemic stroke from the 2021 National Inpatient Sample. Patients were stratified by ZIP code-level income quartiles (Q1: lowest, Q4: highest). Outcomes included inpatient mortality, thrombolysis use, need for mechanical ventilation, and discharge status. Multivariable logistic regression was employed, adjusting for age, sex, race, comorbid conditions, and insurance category.Results Among 536,199 stroke admissions, patients in Q1 were younger, more likely to be uninsured or enrolled in Medicaid, and had a greater prevalence of diabetes, obesity, and substance use disorders. Compared to Q1, Q4 patients had lower adjusted odds of in-hospital death (aOR 0.72; 95% CI 0.64-0.80), ventilator use (aOR 0.75; 95% CI 0.67-0.84), and higher odds of receiving thrombolytic therapy (aOR 1.33; 95% CI 1.23-1.44). Female patients had a lower likelihood of ventilation but were more prone to require post-acute support. Low-income, Medicaid/self-pay coverage, heart failure, atrial fibrillation, and opioid addiction were associated with greater mortality.Conclusion Significant disparities in ischemic stroke outcomes persist based on socioeconomic status, insurance coverage, and demographic factors. Patients from lower-income areas experience higher mortality, less administration of thrombolysis, and greater post-acute care dependency. These findings highlight the necessity for focused strategies to promote fairness in stroke treatment and prognosis.

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