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Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals

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Abstract

We sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (< 25% ethnic/racial minorities [“majority-white hospitals”], 25–50% ethnic/racial minorities [“racially integrated hospitals”], or > 50% ethnic/racial minorities [“minority-serving hospitals”]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospitals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12–1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majority-white hospitals (OR 1.62, 95% CI 1.48–1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11–1.33; p for interaction < 0.001). Ethnic/racial minority patients had similar odds of PEG in any hospital strata, while white patients had increasing odds of PEG in racially integrated and minority-serving compared to majority-white hospitals (OR 1.28, 95% CI 1.15–1.43 in racially integrated, and OR 1.39, 95% CI 1.23–1.57 in minority-serving, compared to majority-white hospitals, p for trend < 0.001). The likelihood of PEG after ischemic stroke was increased in minority-serving compared to majority-white hospitals. White patients had higher odds of PEG in minority-serving compared to majority-white hospitals, indicating a systemic difference in PEG placement across hospitals.

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Funding

Dr. Faigle is supported by an NINDS Career Development Award (K23 NS101124). Dr. Cooper is supported by a grant from the National Heart, Lung, and Blood Institute (K24HL083113). Dr. Gottesman is supported by a grant from the National Institute on Aging (K24AG052573).

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Authors and Affiliations

  1. Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 484, Baltimore, MD, 21287, USA

    Roland Faigle & Rebecca F. Gottesman

  2. Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD, 21287, USA

    Lisa A. Cooper

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Correspondence to Roland Faigle.

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The authors report no other conflicts of interest.

Ethical Approval

Dr. Gottesman is an Associate Editor for Neurology. Because NIS data are publicly available and contains no personal identifying information, this study was exempt from institutional review board approval.

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Faigle, R., Cooper, L.A. & Gottesman, R.F. Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals. Dysphagia 33, 636–644 (2018). https://doi.org/10.1007/s00455-018-9882-y

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