Original ArticleDisparities in Acute Stroke Severity, Outcomes, and Care Relative to Health Insurance Status

BackgroundTo examine the differences in risk factors and length of hospital stay (LOS) between the insured and uninsured stroke patients, identifying the root causes of increasing hospital stay.MethodsRetrospective analysis of stroke registry data of acute stroke patients (N = 19,255) was analyzed to compare risk factors, severity, outcome, and LOS by insurance status. Chart review of patients from a comprehensive stroke center (N = 3290) was studied in greater detail for causes of extended length of stay.ResultsThe uninsured patients had poorer control of risk factors and statistically significantly (P < .0001) higher initial stroke severity, mortality, and LOS as compared with insured patients (3.8 versus 4.5 days, respectively). The increased length of stay was largely accounted for by the inability to transfer uninsured patients to inpatient rehabilitation settings.ConclusionThis study highlights the need for public policies that provide funding for both primary stroke prevention and poststroke rehabilitation.