Association between race, ethnicity, and sex with prehospital identification and outcomes of patients with stroke.
Journal of stroke and cerebrovascular diseases · 2026-07-04 · Observational study
Abstract
BACKGROUND: Stroke is a significant cause of morbidity and mortality. There are racial, ethnic, and sex-based disparities in treatment and outcomes for patients with stroke. This study determined the association between race, ethnicity, and sex and prehospital stroke identification and discharge disposition. METHODS: This was a multi-center, retrospective analysis of adult acute stroke patients presenting via Emergency Medical Services (EMS) between 01/01/2020 and 12/31/2022 who met criteria for inclusion into the local Get with the Guidelines - Stroke registry. Multivariable logistic regression modeled the association between sex, race, and ethnicity and EMS impression, adjusting for age, demographics, stroke severity, presentation with classic stroke symptoms, and EMS agency type (urban, suburban, or rural). Multivariable regression modeled discharge disposition, controlling for receiving hospital stroke certification, cardiovascular risk factors, acute intervention, and the above covariates. RESULTS: A total of 3,749 (83.5%) patients were identified with suspected stroke by EMS. After adjusting for covariates, males had greater odds of identification as a stroke compared to females (adjusted odds ration [aOR] 1.26, 95% CI 1.08-1.47); non-White patients had similar odds of identification as a stroke patient compared to White patients (aOR 1.00, 95% CI 0.55-1.82). Males also had higher odds of dying in hospital or being discharged to hospice compared to females (aOR 1.43, 95% CI 1.08-1.88). CONCLUSION: Male patients were more likely recognized as stroke by prehospital clinicians but had greater odds of a poor discharge disposition. Additional research into causes of these disparities in prehospital stroke identification may improve prehospital patient care and change ultimate outcomes.