Abstract Body: Background: Prior literature has reported patterns of racial differences in percutaneous endoscopic gastrostomy (PEG) placement for patients with post-stroke dysphagia. Reasons for this disproportion are not well understood, but critical for clinical decision making. Long-term implications for PEG placement are considerable, given complication rates and that reducing oral intake can significantly impact recovery of swallow function. In this population-based study, we evaluated the influence of patient-related factors and stroke characteristics on PEG placement.
Methods: All patients, 18 years or older, hospitalized with either ischemic or hemorrhagic stroke in Greater Cincinnati in 2010, 2015, and 2020 were considered for this study. Patients who died within 3 days or transferred to hospice care were not included. Demographics and clinical characteristics of Black and White individuals were compared. Multivariable logistic regression was then used to examine the association between Black race and PEG placement after adjustment for potential confounders. Univariable and multivariable logistic regression analysis (dependent = PEG) was used to determine influential factors for PEG placement. Patient and stroke characteristics between Black and Non-Black patients were compared using Chi-square tests, two-sample t-tests, or Wilcoxon rank-sum tests.
Results: The final sample included 2315 cases, of whom 28.2% were Black (653/2315) and 54.1% were women (1254/2315). Black individuals with stroke were younger (p<0.0001), more likely to have a prior stroke (p=0.0003), had more severe strokes based upon NIHSS (p<.0001), were less likely to be treated at an academic center (p<0.0001), and were more likely to have a PEG placed (p>0.0001).Multivariable analysis revealed that Black race remained associated with PEG placement even after adjustment for potential confounders (aOR 1.47, 95% CI 1.15-1.87).
Discussion: Black stroke patients are more likely to receive PEG, even after adjustment for potential confounders. Additional analyses are underway looking at potential influence of socioeconomic characteristics, patient comorbidities, and lesion location. Given the importance of clinical decision making for alternative access to nutrition and hydration, with the goal of recovery of swallowing function, future studies should examine influence of patient-specific factors including health literacy, familial support, and cultural/patient preferences.