Purpose: Whether there are racial disparities among stroke patients in terms of hospital discharge disposition has not been examined in a modeling framework that controls for covariates affecting multiple discharge dispositions following stroke. We examine racial disparities in discharge disposition using population-based data from Maryland.

Methods: We use de-identified patient-level discharge data maintained by the Health Services Cost Review Commission of Maryland, which include data on all patients that were admitted to medical facilities in Maryland from January 2000 until September 2003. The sample contains 53,090 hospitalizations. Discharge disposition (y) is ranked in order of decreasing desirability as follows: 1=discharge to home without home medical care; 2=discharge to home with medical care; 3=discharge to any medical care facility; 4=death. In order to analyze the independent role of African-American status on the discharge disposition we estimate a Generalized Ordered Logit regression that includes the following covariates: age, gender, race, diagnosis of atrial fibrillation, diagnosis of hemorrhagic stroke, a modified Charlson Comorbidity Index, and length of stay in intensive care. Parameters of the Generalized Ordered Logit model are estimated using generalized estimating equations in order to account for clustering of patients within hospitals.

Results: The estimation results indicate that African-Americans are consistently more likely than whites to be in higher-ranked (i.e. less-desirable) discharge categories, even after controlling for other factors that affect discharge disposition such as gender, age, comorbidities, type of stroke, and length of stay in intensive care units. The race variable is statistically significant at the 1 percent level in all three logits. The odds (95 percent confidence interval) of a discharge to the top- (y=4), top two- (y=4,3), and top three- (y=4,3,2) ranked discharge categories are 1.13 (1.04—1.22), 1.43 (1.32—1.55), and 1.45 (1.33—1.57).

Conclusions: African-American race is an independent and consistent predictor of worse discharge outcomes among stroke patients in Maryland. This relationship remains even after controlling for the effects of age, gender, comorbidities, and stroke type on the discharge disposition. This result is consistent with prior reports of lower survival rates among African Americans but suggests that the racial disparity persists among survivors.