Stroke Systems of Care: Evaluating Disparities after Stroke Legislation Implementation in Rhode Island
Teshome, A. A.; Feler, J. R.; Taman, M.; Porto, C.; Perelstein, E.; Cort, M.; Shaaya, E.; Moldovan, K.; Torabi, R.; Wolman, D. N.; Jayaraman, M. V.; Proulx, J. A.
Show abstract
IntroductionThe Rhode Island Stroke Prevention and Treatment Act aimed to establish a standardized system of care for stroke patients through designated stroke centers, revise emergency medical services (EMS) protocols, and establish a centralized stroke database. While Stroke Systems of Care (SSOC) laws have proven effective in reducing overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear. This study investigates the impact of the Act on stroke mortality rates across different racial groups. MethodsData from the Rhode Island Department of Labor and Training, CDC Atlas of Heart Disease and Stroke, and U.S. Census Bureau for 2005-2019 were analyzed. A difference-in-difference analysis compared mortality rates among White, Black, and Hispanic residents before and after the Acts implementation. Trends were further validated using a mixed-effects model. ResultsFollowing SSOC implementation, the White group had significant reductions in ischemic stroke mortality (-5.38 per 100,000, 95% CI [-6.63, -4.12]; P<0.001). Analysis did not identify a difference in ischemic stroke mortality in the Hispanic (-2.67, 95% CI [-1.49, 6.83]; P=0.174) or Black group (4.69, 95% CI [-25.40, 16.01]; P=0.638). After Act-driven field triage implementation, there was a decline in all-stroke mortality among Black (-15.9 per 100,000, 95% CI [-30.52, -1.19]; P=0.035) and Hispanic (-7.07 per 100,000, 95% CI [-11.81, -2.32]; P=0.005) groups. However, the Black group maintained higher all-stroke mortality compared to the White population (RR 1.34, 95% CI [1.27, 1.41]; P<0.001). ConclusionWhile SSOC significantly reduced overall stroke mortality in Rhode Island, the benefits were not equitably distributed across racial groups. These findings underscore the need for future stroke legislation to incorporate culturally competent, evidence-based strategies addressing social determinants of health to reduce disparities and ensure equitable care.
Matching journals
The top 2 journals account for 50% of the predicted probability mass.
Similar papers in this journal
- Disparities in Access to Vascular Stroke Imaging and Carotid Revascularization: A Population Study 96%
- Persistent Inequities in Intravenous Thrombolysis for Acute Ischemic Stroke in the U.S.: Results from the NIS 95%
- A Claims-Based Machine Learning Classifier of Modified Rankin Scale in Acute Ischemic Stroke 95%
Similar papers in this journal
- Leveraging Machine Learning for Enhanced and Interpretable Risk Prediction of Venous Thromboembolism in Acute Ischemic Stroke Care 93%
- Practitioner, patient and public views on the acceptability of Mobile Stroke Units in England and Wales: a mixed methods study 92%
- Continuous administration of the p38α inhibitor neflamapimod during the subacute phase after transient ischemia-induced stroke in the rat promotes dose-dependent functional recovery accompanied by increase in brain BDNF protein level 92%
Similar papers in this journal
- Vascular Risk Factor Prevalence and Trends in Native Americans With Ischemic Stroke - A National Inpatient Sample Analysis 96%
- Documented Goals of Care Conversations with Hospitalized Patients after Severe Stroke 95%
- Modified Rankin Scale Disability Status at Day 4 Poststroke is an Informative Predictor of Long-Term Day 90 Outcome 94%
Similar papers in this journal
- When two communication differences intersect: Comparing inpatient rehabilitation care and outcomes for people with post-stroke aphasia who do and do not require an interpreter 95%
- Normobaric Hyperoxia Combined with Endovascular Treatment Based on Temporal Gradient: A dose-escalation study 94%
- Prospective Observational Cohort Study Of Tenecteplase Versus Alteplase In Routine Clinical Practice 94%
Similar papers in this journal
- Rapid Clinical Screening and Staging for COVID-19 Severe Outcome A Hospitalization Study in New York City 92%
- Dynamic cerebral autoregulation during and 3 months after endovascular treatment in large-vessel occlusion stroke 90%
- Endovascular structures of the basilar artery: forms of the basilar nonfusion spectrum 90%
"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.