COVID-19 pandemic worsened stroke outcomes, exacerbated disparities
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Key takeaways:
- Comorbid acute ischemic stroke and COVID-19 increased the rate of stroke mortality in 2020.
- Hispanic individuals and people with low income were disproportionately impacted by the increase.
Comorbid acute ischemic stroke and COVID-19 increased the rate of stroke mortality in 2020, researchers reported.
The increase was especially pronounced in Hispanic populations and individuals with lower levels of household income.
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“Our results confirm the harmful effects of comorbid acute ischemic stroke and COVID-19 and expand them to a nationally representative sample,” Adam de Havenon, MD, MSCI, associate professor of neurology at Yale School of Medicine, and colleagues wrote in the Stroke.
To determine the impact of the COVID-19 pandemic on acute ischemic stroke outcomes, de Havenon and colleagues created a cross-sectional cohort of nonelective hospital discharges aged 18 years or older with an ischemic stroke diagnosis in the National Inpatient Sample database from 2016 to 2020.
In addition, the NIH Stroke Scale was used to determine the impact of COVID-19 on the severity of acute ischemic stroke.
Researchers determined how sociodemographic features including age, sex, race and ethnicity and socioeconomic status affected the relationship between COVID-19 status and acute ischemic stroke.
The researchers found that acute ischemic stroke mortality rates were higher in 2020 than from 2016 to 2019 (7.3% vs. 6.3%; P < .001). The difference was less, but still significant, when the 2020 data included only patients with acute ischemic stroke and no COVID-19 (2020, 6.6%; 2016-2019, 6.3%; P = .001).
Among patients hospitalized with acute ischemic stroke between April and December 2020, in-hospital mortality was higher in those who had COVID-19 than in those who did not (29.6% vs. 6.6%; P < .001), according to the researchers.
In addition, the severity of stroke was higher when the stroke was paired with COVID-19 exposure compared with those who did not have COVID-19 exposure (NIH Stroke Scale scores: COVID-19, 9.7; no COVID-19, 6.6; P < .001).
In the secondary analysis of sociodemographic characteristics, researchers found that Hispanic individuals had a significantly increased risk of in-hospital acute ischemic stroke mortality in April to December 2020 compared with 2019 (9.2% vs. 5.8%; P < .001). The same was true for individuals in the lowest quartile of income (8% vs. 6%; P < .001).
“The importance of these findings is that in future pandemics we might anticipate similar disparity exacerbations in vulnerable subgroups of ischemic stroke patients,” de Havenon and colleagues wrote.
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