Three studies presented throughout the ongoing Society of NeuroInterventional Surgery (SNIS) annual meeting (20–24 July, Seattle, USA) have shown that racial, geographic and socioeconomic disparities continue to influence stroke treatment and outcomes across the USA. Together, these findings suggest that, while advances in stroke care have improved survival and expanded treatment options, not all patients are benefitting equally.
In the first study—a national inpatient sample analysis—co-first authors Muhammed Amir Essibayi (Albert Einstein College of Medicine, New York City, USA) and Hasan Jamil (St Luke’s International University, Tokyo, Japan) evaluated more than 325,000 acute ischaemic stroke patients treated at US teaching hospitals between 2018 and 2022.
They found that Black patients were less likely than white patients to receive an endovascular thrombectomy procedure. This disparity existed across all levels of stroke severity and increased as stroke severity worsened, with Black women consistently the least likely to receive treatment; at a National Institutes of Health stroke scale (NIHSS) score of 20, the predicted probability of receiving thrombectomy was 33% for white men, 32% for white women, 28% for Black men and 26% for Black women.
“As stroke severity increases, timely access to thrombectomy becomes increasingly important, yet our findings suggest treatment disparities also become more pronounced,” said Essibayi. “Understanding how race, sex and stroke severity intersect may help health systems identify opportunities to ensure patients have equitable access to lifesaving treatment.”
A second study—RISE-HD—examined more than 120,000 patients hospitalised with haemorrhagic stroke in the US state of Florida between 2013 and 2024. While researchers found that mortality rates declined significantly during the study period, substantial disparities persisted among patients from different racial, geographic and socioeconomic backgrounds.
After adjusting for age, sex and comorbidities, Black patients were found to experience higher odds of in-hospital mortality than white patients. Patients living in rural areas and those insured through Medicaid or other non-commercial insurance plans also faced significantly higher mortality rates. Researchers identified regional differences in outcomes across the state too, highlighting potential gaps in access to specialised stroke care.
“The encouraging decline in mortality over the past decade demonstrates meaningful progress in stroke care, but our findings show that significant barriers remain,” said primary study author Natália Vasconcellos (Thomas Jefferson University Hospital, Philadelphia, USA). “Addressing disparities in access to specialised stroke systems, particularly for underserved communities, will be critical to improving outcomes for all patients.”
In the third and final study, researchers analysed haemorrhagic stroke mortality across 433 counties in the ‘Stroke Belt’ region located in the southeast of the USA to examine factors associated with differences in outcomes between rural and urban communities. The study evaluated distance to the nearest comprehensive stroke centre (CSC), community-level socioeconomic disadvantage, racial and economic segregation, and human immunodeficiency virus (HIV) burden.
The rural and urban findings were markedly different, according to the researchers. In rural counties, longer travel times to CSCs were more strongly associated with mortality—while, in urban counties, racialised economic segregation and HIV burden were more strongly associated with poorer outcomes despite closer geographic access to specialised care.
“The neurointerventional access problem in the Stroke Belt is not one problem, it is two,” commented Dylan Yates (Tulane University School of Medicine, New Orleans, USA). “In rural communities, improving access means expanding stroke transfer networks and strengthening connections to CSCs. In urban communities, addressing structural disadvantage and investing in underserved neighbourhoods is critical. These findings show that the neurointerventional access gap differs between rural and urban communities, and suggest that improving outcomes will require different strategies in each.”
An SNIS press release concludes that, in combination, these three studies underscore the need for continued efforts to address inequities in stroke prevention, treatment and access to specialised care. Researchers state that targeted interventions—including improved stroke transfer networks, expanded access to specialty care, and more equitable treatment pathways—may help reduce disparities and improve outcomes for patients across the USA.
