OBJECTIVES: Racial health disparities in acute ischemic stroke (AIS) are documented across the patient journey, from incidence to treatment access. Equity-informative cost-effectiveness analyses, such as distributional cost-effectiveness analysis (DCEA), can allow for clear quantification of disparities and can estimate the equity consequences of treatment and access decisions. The objective of this review is to summarize existing disparities across race and ethnicity as well as social determinants of health in AIS to inform DCEA.

METHODS: We conducted a targeted search of MEDLINE and Google Scholar (English language, US studies, past 10 years) for literature investigating the impact of race/ethnicity and social deprivation indices (SDIs) on selected AIS outcomes relevant to economic modeling, including incidence, inpatient mortality, post-stroke disability, readmission, inpatient intracranial hemorrhage, mortality, hospitalization cost, and post-discharge care costs.

RESULTS: The search yielded 1349 results, with 53 articles selected for full-text review. Consistent evidence across studies demonstrated that Black individuals have a higher risk of incident AIS, post-stroke disability, and increased hospitalization costs, relative to Whites, but only limited evidence was identified that suggested similar increased risks for Hispanic and Asian individuals. For example, after adjusting for age and other factors, Black individuals in the US veteran population experienced 39.3 (95%CI, 13.1-65.5) and 532.5 (95%CI, 301.8-781.0) more strokes per 100,000 persons in individuals aged 60-79 and ≥80, respectively, compared to Whites. Additionally, other consistent evidence suggests increased risk of inpatient intracranial hemorrhage in Black, Hispanic, and particularly Asian individuals.

CONCLUSIONS: Existing literature demonstrates important distributional differences across race and ethnicity that can be modeled in DCEA. However, more evidence is needed to determine if inpatient and overall mortality varies by race/ethnicity and to better understand how AIS outcomes are impacted by broader social determinants of health.