Nationwide Analysis of Palliative Care Utilization Among Ischemic Stroke Hospitalizations.
- 1Neurology Department, Creighton University, Omaha, NE 68124, USA.
- 2Department of Clinical Research and Public Health, School of Medicine, Creighton University, Omaha, NE 68124, USA.
- 3School of Medicine, Creighton University, Omaha, NE 68124, USA.
Abstract
Background/Objectives: Palliative care (PC) is an integral component of ischemic stroke management, yet contemporary nationwide data on its utilization, recent utilization rates, and associated disparities are lacking. This study examined PC utilization rates, demographic disparities, and clinical factors associated with receipt of PC (PC) across ischemic stroke hospitalizations in the United States (US) from 2016 to 2022. Methods: This retrospective cross-sectional study used data extracted from the National Inpatient Sample (NIS) to identify adult hospitalizations primary for ischemic stroke, identified via validated International Classification of Disease-10th Clinical Modification (ICD-10-CM) codes. PC use was identified using the code Z51.5. Multivariable logistic regression was performed to identify factors independently associated with PC, adjusting for demographics, hospital characteristics, clinical severity (National Institutes of Health Stroke Scale [NIHSS] category, Charlson Comorbidity Index), complications, and receipt of thrombolysis/thrombectomy. Results: Among 4350,924 weighted ischemic stroke hospitalizations, 253,555 (5.83%) received PC, ranging from 5.34% in 2016 to 6.40% in 2022. Hospitalizations involving Black (adjusted odds ratio [aOR], 0.71; 95% CI, 0.69-0.74) and Hispanic (aOR, 0.73; 95% CI, 0.70-0.77) individuals had significantly lower odds of PC receipt compared with those involving White individuals. Lower-income quartiles, rural hospitals, and non-teaching hospitals were independently associated with reduced odds of PC receipt. Compared with NIHSS scores of 0-9, higher NIHSS scores demonstrated a graded association with PC use (NIHSS 20-29: aOR, 8.53; NIHSS 30-39: aOR, 12.22). Malignant neoplasm (aOR, 3.83), respiratory failure (aOR, 3.04), and cerebral edema (aOR, 2.82) showed clinically large statistically significant associations with PC. Receipt of reperfusion therapies were inversely associated with PC use (aOR, 0.85 for thrombolysis; aOR, 0.71 for thrombectomy). Conclusions: PC utilization among ischemic stroke hospitalizations remains low, with persistent racial/ethnic, socioeconomic, and institutional disparities. System-level interventions are needed to expand equitable PC access across all stages of ischemic stroke care, including patients who receive reperfusion therapies.
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BibTeX
@article{asghar2026nationwide,
title = {{Nationwide Analysis of Palliative Care Utilization Among Ischemic Stroke Hospitalizations.}},
author = {Muhammad Roshan Asghar and Ali Al-Salahat and Alexander Hall and Nicole Horio and Nirmala Persaud and Ripudaman Kahlon and Jagkirat Singh and Rohan Sharma},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/healthcare14193194},
url = {https://europepmc.org/article/MED/42881640},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nationwide Analysis of Palliative Care Utilization Among Ischemic Stroke Hospitalizations.
AU - Muhammad Roshan Asghar
AU - Ali Al-Salahat
AU - Alexander Hall
AU - Nicole Horio
AU - Nirmala Persaud
AU - Ripudaman Kahlon
AU - Jagkirat Singh
AU - Rohan Sharma
PY - 2026
DA - 2026/09/28
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193194
UR - https://europepmc.org/article/MED/42881640
AB - Background/Objectives: Palliative care (PC) is an integral component of ischemic stroke management, yet contemporary nationwide data on its utilization, recent utilization rates, and associated disparities are lacking. This study examined PC utilization rates, demographic disparities, and clinical factors associated with receipt of PC (PC) across ischemic stroke hospitalizations in the United States (US) from 2016 to 2022. Methods: This retrospective cross-sectional study used data extracted from the National Inpatient Sample (NIS) to identify adult hospitalizations primary for ischemic stroke, identified via validated International Classification of Disease-10th Clinical Modification (ICD-10-CM) codes. PC use was identified using the code Z51.5. Multivariable logistic regression was performed to identify factors independently associated with PC, adjusting for demographics, hospital characteristics, clinical severity (National Institutes of Health Stroke Scale [NIHSS] category, Charlson Comorbidity Index), complications, and receipt of thrombolysis/thrombectomy. Results: Among 4350,924 weighted ischemic stroke hospitalizations, 253,555 (5.83%) received PC, ranging from 5.34% in 2016 to 6.40% in 2022. Hospitalizations involving Black (adjusted odds ratio [aOR], 0.71; 95% CI, 0.69-0.74) and Hispanic (aOR, 0.73; 95% CI, 0.70-0.77) individuals had significantly lower odds of PC receipt compared with those involving White individuals. Lower-income quartiles, rural hospitals, and non-teaching hospitals were independently associated with reduced odds of PC receipt. Compared with NIHSS scores of 0-9, higher NIHSS scores demonstrated a graded association with PC use (NIHSS 20-29: aOR, 8.53; NIHSS 30-39: aOR, 12.22). Malignant neoplasm (aOR, 3.83), respiratory failure (aOR, 3.04), and cerebral edema (aOR, 2.82) showed clinically large statistically significant associations with PC. Receipt of reperfusion therapies were inversely associated with PC use (aOR, 0.85 for thrombolysis; aOR, 0.71 for thrombectomy). Conclusions: PC utilization among ischemic stroke hospitalizations remains low, with persistent racial/ethnic, socioeconomic, and institutional disparities. System-level interventions are needed to expand equitable PC access across all stages of ischemic stroke care, including patients who receive reperfusion therapies.
SN - 2227-9032
ER -