Despite Increase in Certified Stroke Centers, Racial Disparities Persist

Despite an increase in the number of certified stroke centers in each population’s communities, racial disparities persist among Black and White patients with acute ischemic stroke diagnoses, according to a study published in JAMA Network Open.¹

“The introduction of intravenous thrombolytics in the 1990s and endovascular thrombectomy in 2015 marked key milestones in reducing disability and improving functional recovery among eligible patients with stroke,” wrote the authors.¹ “However, these interventions require substantial resources, including imaging technology, specialized medical devices, and trained personnel.”

According to a study published in the Journal of the American College of Emergency Physicians, there are close to 2500 stroke centers operating across the country, accounting for a significant proportion (44%) of emergency department destinations in the US.² Despite the sheer volume of certified stroke centers in the country, there are still factors that make the care provided at some centers more advanced than others.

Researchers of the current study wanted to better understand inequalities in stroke outcomes and targeted care among Black and White patients. | image credit: daniiD / stock.adobe.com

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While some centers can perform more advanced interventions than others, there have also been reports of higher-level outcomes and treatments at stroke centers in wealthier, predominantly White communities. Many factors like low per-capita access and socioeconomic disadvantages have contributed to disparities among Black and White patients.

With continuous disparities within the care provided to patients experiencing stroke, researchers of the current study wanted to better understand these inequalities.

“What remains unknown is whether the certification of a nearby stroke center is associated with equal benefits for Black and White patients,” continued the authors. “This question is critical for informing equitable policy decisions around resource allocation. To address this, we analyzed 11 years of patient-level data from Medicare (2009-2019) to assess patterns in admission, treatment, and outcomes by race after stroke center certification.”

The researchers’ analysis included Medicare fee-for-service beneficiaries residing in urban communities who also reported primary diagnoses of acute ischemic stroke from January 2009 to December 2019. They also explored patient data and presented changes in outcomes among Black and White patients.

The final analysis included a total of 2.11 million patients (85% White; 57% women; 32% over the age of 84). Among the study population, 87% of White patients and 93% of Black patients lived in a community that gained a newly certified stroke center within a 30-minute drive during the study period. However, regarding specific variations of new stroke centers across these communities, White patients (20%) lived closer to primary stroke centers than Black patients (13%).

“Among White patients, exposure to a newly certified stroke center was associated with higher rates of thrombolytic therapy compared with White patients in the control community,” wrote the authors. “For Black patients, however, the likelihood of receiving thrombolysis and thrombectomy decreased after the community experienced newly certified stroke centers relative to Black patients in communities without stroke center expansion. These disparities appeared to be associated with exposure to higher-level stroke centers.”

Overall, both Black and White patients experienced an uptick in thrombolytic therapy and acute stroke interventions. However, as certified stroke centers increased for both populations throughout the study, stroke interventions increased significantly faster for White patients compared with Black patients.

While the researchers’ findings did not suggest a decrease or eradication of stroke services for Black patients, they did highlight a significant disparity between the 2 groups.

“Recent studies have examined interventions designed to reduce traditional stroke risk factors (eg, primary and secondary hypertension, diabetes), and to improve awareness of stroke symptoms, access to care, and quality of care,” wrote authors of a study published in Stroke.³ “While interventions that target traditional risk factors, such as blood pressure, have been successful, the quality of stroke care and patient outcomes continue to differ according to race.”

Despite notable expansion of stroke services in both Black and White communities, the study investigators still uncovered persistent disparities, leading to the need for more concerted efforts to address this inequality. As more stroke centers receive certifications, researchers believe all patients’ outcomes should be held in high regard.

“Black patients experiencing newly certified [thrombectomy-capable stroke centers] and [comprehensive stroke centers] near their communities experienced a decreased likelihood of receiving thrombectomy compared with Black patients who did not experience any stroke center openings and had no differential change in mortality,” they concluded.¹ “If the benefits associated with stroke center certification are concentrated among White patients and serve to widen rather than narrow the known disparities in acute stroke care, a more targeted approach may be necessary to address stroke care disparities directly.”

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References

1. Shen Y, Kim AS, Hsia RY. Outcomes for Black and White patients after certification of nearby stroke centers. JAMA Netw Open. 2025;8(7):e2522019. doi:10.1001/jamanetworkopen.2025.22019

2. Boggs KM, Vogel BT, Zachrison KS, et al. An inventory of stroke centers in the United States. J Am Coll Emerg Physicians Open. 2022 Feb 28;3(2):e12673. doi: 10.1002/emp2.12673.

3. Ikeme S, Kottenmeier E, Uzochukwu G, et al. Evidence-based disparities in stroke care metrics and outcomes in the United States: a systematic review. Stroke. 2022;53(3). https://doi.org/10.1161/strokeaha.121.036263