Healthcare cost and race: analysis of young women with stroke

Abstract

Background: Over the last decade, the prevalence of young stroke has increased 40% particularly among vulnerable populations. These strokes are often more severe with worse outcomes. However, few studies have examined the impact on annual healthcare costs. Methods: Data from the 2008 to 2018 Medical Expenditure Panel Survey (MEPS) was used to identify a sample of female stroke survivors aged 18 and 60. MEPS includes demographics, health status, healthcare use, and expenditures for all participants providing the largest nationally representative data source of healthcare costs in the US. First, differences in racial and ethnic healthcare expenditure among young women with stroke were evaluated controlling for insurance type and demographic characteristics. Second, the relationship between healthcare expenditure and 1) time post stroke, 2) comorbidities, 3) healthcare utilization, and 4) post-stroke functional status was assessed. Finally, differential healthcare quality was tested as a potential mitigating differential. Results: Young Black women with stroke spend roughly 20% more on healthcare than White women after controlling for insurance, time post-stroke, healthcare utilization, and demographic differences. Costs remain 17% higher after controlling for comorbidities. Differences in expenditure are larger if survivors have diabetes, high blood pressure, or high cholesterol (78%, 24%, and 28%, respectively). Higher expenditure could not be explained by higher healthcare utilization, but lower quality of healthcare may explain part of the differential. Conclusion: Young Black women with stroke have 20% greater healthcare expenditure than other groups. Cost differentials cannot be explained by differentials in comorbidities, utilization, time post stroke, or functionality. Additional research is needed to explain these differences.