Risultati per: GPG: Versione 5.7.0 (Maggio 2021)

Objectives
We aimed to analyse the disease burden and trends related to household air pollution (HAP) from 1990 to 2021 and to assess the correlation between development status and HAP burden using the Sociodemographic Index (SDI).

Design
Observational study using data from the global burden of disease (GBD) 2021.

Main outcomes and measures
The GBD results tool provided comprehensive data on disability-adjusted life years (DALYs) attributable to HAP, stratified by age, sex, year, and geographical location.

Results
A significant reduction of approximately 50% in global HAP-related DALYs was observed between 1990 and 2021. However, a minor increase in HAP-related DALYs was noted between 2020 and 2021. The highest burden was found in children under five. Males generally had higher DALY rates than females. A negative correlation was identified between SDI and HAP-related DALY rates, with the highest rate in Oceania and the lowest in high-income North America. Maternal and neonatal disorders, cardiovascular diseases, respiratory infections and tuberculosis, and chronic respiratory diseases were the leading causes of HAP-related DALYs.

Conclusion
The study highlighted the progress in reducing the global burden of HAP-related diseases, yet it also revealed persistent disparities that require targeted public health interventions. Continued efforts to promote cleaner energy solutions and address regional, age and gender-specific vulnerabilities are essential for further reducing the health impact of HAP. Future research should focus on understanding the contributing factors to these disparities and developing innovative mitigation strategies.

Objective
To estimate the prevalence of coronary heart disease (CHD) in Mauritius. Over the last half century, rapid socioeconomic development has taken place in the multiethnic Mauritius. It is unclear if this is paralleled with an increasing prevalence of CHD.

Design
Repeated cross-sectional population-based studies.

Setting
Mauritius.

Participants
Seven population-based surveys were performed in Mauritius between 1987 and 2021. Altogether, 29 997 participants aged 35–74 years were included.

Measures
Except in 2004 and 2021, all participants were examined with an ECG. ECG changes were classified as ‘probable CHD’ and ‘possible CHD’ according to the Minnesota Code model. Participants were asked about previous myocardial infarction, stroke and angina pectoris as told by a doctor. An affirmative answer to any of these questions was labelled as the presence of cardiovascular disease (CVD). Since 2009, questions about previous coronary bypass surgery and percutaneous coronary intervention were included. The prevalence estimates were age and sex standardised to the 2008 Mauritian population. Multivariable logistic regression evaluated associations between traditional CVD risk factors and CHD.

Results
The prevalence (with 95% CI) of probable CHD according to ECG did not increase between 1987 and 2015, 1.6% (1.2–2.1%) and 1.9% (1.5–2.3%), respectively, whereas the prevalence of possible CHD decreased, 23.7% (22.3–25.1%) and 17.3% (16.2–18.3%), respectively. Self-reported CVD did not increase between 1987 and 2021. Male sex, diabetes, impaired glucose tolerance (IGT), hypertension, smoking and self-reported history of CVD were associated independently with probable CHD, whereas female sex, IGT, hypertension, high cholesterol and self-reported history of CVD were associated independently with possible CHD. Ethnicity did not associate with probable CHD but with possible CHD. Postload plasma glucose associated with probable and possible CHD.

Conclusions
The prevalence of probable CHD according to ECG and the prevalence of self-reported history of CVD did not increase in Mauritius. Traditional cardiovascular risk factors were associated significantly with the presence of probable and possible CHD.

Objectives
We aimed to analyse the trends, age distribution and disease burden of maternal sepsis and other maternal infections (MSMI) to improve management strategies.

Design
We extracted data from the global burden of disease (GBD) 2021 database to evaluate MSMI burden with different measures for the whole world, 21 GBD regions and 204 countries from 1990 to 2021.

Setting
Studies from the GBD 2021 database generated by population-representative data sources identified through a literature review and research collaborations were included.

Participants
Patients with an MSMI diagnosis.

Outcomes
Total numbers, age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) on MSMI from the GBD 2021 study and their estimated annual percentage changes (EAPCs) were the primary outcomes.

Results
There were 19 047 404 (95% uncertainty interval (UI) 14 608 563 to 24 086 486) annual incident cases, 2 376 876 (95% UI 1 678 868 to 3 421 377) prevalent cases at a single time point, 17 665 (95% UI 14 628 to 21 191) death cases and 1 144 233 (95% UI 956 988 to 1 352 034) DALYs of total MSMI in 2021. From 1990, the case number and ASRs of incidences and prevalence showed decreasing trends, while the case number and ASRs of mortality and DALYs gradually increased with time, reaching the peak in 2001, and then declined. In 2021, the ASRs of incidence, prevalence, mortality and DALYs sharply increased with age, which reached the peak in the 20–24 age group. The ASRs were decreased with increasing sociodemographic index (SDI). In 2021, it showed a positive correlation between EAPC and ASR of DALYs (r=0.3398, p

Objective
With the increasing prevalence of antimicrobial resistance (AMR), the rational use of antibiotics is crucial. This study aimed to evaluate the antibiotic use patterns and influencing factors of compliance in Shanxi Province Hospitals between 2015 and 2021 and provide data support for the management of antibiotics.

Design
This was a retrospective observational study of trends in antibiotic use and data reporting trends in the context of antimicrobial stewardship (AMS).

Data sources
The analysis involved annual antibiotic data from hospitals covered by China’s National Clinical Improvement System (NCIS). We obtained information on hospital characteristics (eg, city, a deidentified hospital code and hospital level) from Shanxi Provincial Pharmaceutical Quality Control Centre.

Eligibility criteria
Our study included Shanxi hospitals that reported annual antibiotic data to the NCIS system in any year between 2015 and 2021.

Results
The number of hospitals reporting antibiotic data has increased annually. Between 2015 and 2021, a total of 221 hospitals in 11 cities were analysed. The proportion of patients undergoing clean surgical procedures with prophylactic antibiotic prescriptions decreased from 45.08% to 40.0% between 2019 and 2021, with a compound annual growth rate (CAGR) of –5.80 (p=0.103). The intensity of antibiotic treatment among inpatients was from 42.00 to 39.70 daily defined dose between 2017 and 2021, with a CAGR of –1.40 (p=0.015). The proportion of inpatients with antibiotic prescriptions decreased from 51.42% to 47.14% between 2015 and 2021, with a CAGR of –1.44 (p

Background
Governments used travel bans during the COVID-19 pandemic to limit the introduction of new variant of concern (VoC). In the Netherlands, direct flights from South Africa were banned from 26 November 2021 onwards to curb Omicron (B.1.1.529) importation.

Objectives
This study retrospectively evaluated the effect of the South African travel ban and the timing of its implementation on subsequent Omicron infections in the Netherlands and, in order to help inform future decision-making, assessed alternative scenarios in which the reproduction number (Re) and volume of indirectly imported cases were varied.

Design
Descriptive analysis and modelling study.

Outcome measure
Time (days) from 26 November 2021 to reach 10 000 cumulative Omicron infections in the Netherlands.

Methods
To benchmark the direct importation rate of Omicron from South Africa, we used the proportion (n/N, %) of passengers arriving on two direct flights from South Africa to the Netherlands on 26 November 2021 with a positive PCR sequencing result for Omicron VoC infection. We scaled the number of directly-imported Omicron infections before and after the travel ban to the incidence in South Africa. We assumed that 10% of all cases continued to arrive via indirect routes, a ‘failure rate’ of 2% (ie, incoming Dutch citizens not adhering to quarantine on arrival) and an effective reproduction number (Re) of Omicron of 1.3. In subsequent analyses, we varied, within plausible limits, the Re (1.1–2.0) and proportion of indirectly-imported cases (0–20%).

Results
Compared with no travel ban, the travel ban achieved a 14-day delay in reaching 10 000 Omicron cases, with an additional day of delay if initiated 2 days earlier. If all indirect importation had been prevented (eg, European-wide travel ban), a 21-day delay could have been achieved. The travel ban’s effect was negligible if Re was ≥2.0 and with a greater volume of ongoing importation.

Conclusions
Travel bans can delay the calendar timing of an outbreak but are substantially less effective for pathogens where importation cannot be fully controlled and tracing every imported case is unfeasible. When facing future disease outbreaks, we urge policy-makers to critically weigh up benefits against the known socioeconomic drawbacks of international travel restrictions.

Objectives
To investigate the prevalence and potential determinants of cost-related non-adherence (CRNA) in US adults with heart failure (HF).

Design
A serial cross-sectional analysis using nationally representative data from 2012 to 2021 of the US Medical Expenditure Panel Survey.

Setting
Population-based.

Participants
Adult participants with HF diagnosis.

Outcome measures
Self-report of never getting or delaying getting prescription medicine because of costs.

Results
We included 1753 patients with HF (mean age 69.36 [95% CI, 68.23 to 70.48]) years, 47.85% men and 17.09% non-Hispanic Black. The overall weighted prevalence of CRNA was 7.94% (6.40–9.81), increasing from 3.09% (1.29–7.24) in 2012 to 13.69% (8.99–20.32) in 2018 and decreasing to 8.71% (3.82–18.67) in 2021. The prevalence of CRNA was higher among patients

Background
GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15–64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being.

Objective
To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP.

Design
The 2021 Global Burden of Disease study dataset was used to obtain estimates of GI cancer incidence and 95% uncertainty intervals, including the number of cases, crude incidence rate and age-standardised incidence rate (ASIR). WAP GI cancer epidemiology was assessed at the national, regional and global levels, evaluating trends from 1990 to 2021 from overall, local and Sociodemographic Index (SDI) perspectives and using standard health equity methods to quantify cross-country inequality.

Results
Colorectal cancer exhibited the greatest burden of GI cancer among the WAP in 2021. From 1990 to 2021, the number of GI cancer cases rose by 51.9%, although the ASIR declined by 23.4%. These rates exhibit geographic variation, with the most cases and the highest ASIR in China and Mongolia, respectively. Incidence was disproportionately concentrated in higher SDI countries, and worsening inequality was evident over time.

Conclusions
While the ASIR of GI cancer is trending downwards among the WAP, high incidence rates, regional variability and an unequal burden of disease emphasise the need for flexible, targeted medical interventions to support policymaking and medical resource allocation.

We read with great interest the study by Danpanichkul et al,1 which assessed the global burden of gastrointestinal cancers, including oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers, from 2000 to 2021. The study revealed that the burden of all types of cancers varies across geographical and socioeconomic levels. The incidence rates of some types of gastrointestinal cancer in higher sociodemographic index (SDI) countries tend to decrease or increase at a slower rate compared with the more significant rise observed in lower SDI countries. Another study on global gastrointestinal cancer also noted that the incidence tends to be concentrated in countries with higher SDI.2 In this global context, quantifying the inequalities in the burden of gastrointestinal cancers across countries is crucial for informing targeted strategies and optimising future efforts to reduce the global disparities in cancer burden. We use the SDI to represent the…

Objectives
Parkinson’s disease (PD) has become a public health concern with global ageing. With a focus on PD, this study sought to project its burden and trends at the national, regional and worldwide levels between 1990 and 2021.

Study design
Population-based study.

Methods
The Global Burden of Disease (GBD) 2021 provided the PD burden data. The GBD data are considered globally and regionally representative, as it integrates multiple data sources and employs standardised estimation methods. The age-standardised rate (ASR) and estimated annual percentage change (EAPC) were used to estimate trends in the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of PD from 1990 to 2021. ASR was used to calculate the EAPCs using a linear regression model. A Bayesian age-period-cohort model was used to predict future trends up to 2046.

Results
Globally, the overall ASR of PD incidence, prevalence, DALYs and mortality increased from 1990 to 2021. The EAPCs were 1.09 (95% CI: 1.07 to 1.11) for incidence, 1.52 (95% CI: 1.49 to 1.54) for prevalence, 0.32 (95% CI: 0.28 to 0.36) for DALYs and 0.18 (95% CI: 0.13 to 0.23) for mortality. The incidence, prevalence, mortality and DALYs of PD in 2021 were higher in men than in women. The age-standardized incidence rate (ASIR) was 18.52 per 100 000 in men and 12.92 per 100 000 in women (EAPC: 1.11, 95% CI: 1.09 to 1.13 vs 1.07, 95% CI: 1.05 to 1.09). The age-standardized prevalence rate (ASPR) was 157.42 per 100 000 in men and 121.84 per 100 000 in women (EAPC: 1.70, 95% CI: 1.67 to 1.73 vs 1.25, 95% CI: 1.22 to 1.27). The ASMR was 6.57 per 100 000 in men and 3.59 per 100 000 in women (EAPC: 0.21, 95% CI: 0.14 to 0.28 vs –0.01, 95% CI: –0.04 to 0.03). The ASDR was 97.12 per 100 000 in men and 81.23 per 100 000 in women (EAPC: 0.37, 95% CI: 0.33 to 0.42 vs 0.14, 95% CI: 0.10 to 0.18). From 1990 to 2021, the burden of PD remained consistently higher in men than in women, with the gender difference widening with age. The prevalence, incidence, DALYs and mortality rates of PD increased with age before declining, peaking in the 80–84 age group for prevalence and incidence, while peaking in the 90–94 age group for mortality. DALY rates peaked in the 85–89 age group. The ASR of incidence and prevalence increased significantly in Norway (EAPC=3.39, 95% CI: 3.15 to 3.64; EAPC=5.04, 95% CI: 4.65 to 5.43). Lesotho was the nation with the highest rise in age-standardised DALYs for PD (EAPC=1.67, 95% CI: 1.41 to 1.93). The United Arab Emirates had the fastest increase in age-standardised mortality for PD (EAPC=1.98, 95% CI: 1.24 to 2.71). The global ASPR of PD is projected to show a continuous upward trend.

Conclusions
From 1990 to 2021, there were rising trends in the prevalence and burden of PD in most areas and nations worldwide. Our research indicates that the management and control of PD need significant improvement, particularly in light of the ageing population.

Objective
The 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat event (EHE) on the sector as well as the barriers to and facilitators of implementing effective heat response is critical to preparing for future events, which are happening more frequently in the region due to climate change.

Design
Guided by an implementation science framework, we convened listening sessions and focus groups of the health sector in western Washington to reflect on regional response efforts.

Setting
Health sector organisations in 15 counties in western Washington State, USA: Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom.

Participants
A convenience sample of 109 listening group participants was recruited through the professional networks of the Northwest Healthcare Response Network, a regional healthcare coalition. 27 of the health sector professionals were recruited using purposive sampling to participate in seven focus groups organised by organisation type.

Results
The co-presence of the COVID-19 pandemic, limited staff capacity, resource acquisition challenges and inadequate regional collaboration emerged as key barriers, while advanced planning, indoor cooling capabilities, adapting strategies to local needs, robust internal relationships and strong external partnerships were reported to facilitate effective response. Establishing centralised coordination ahead of heat events, making improvements to the cooling capabilities of the built environment, developing plans and policies for EHEs that have co-benefits for other events, adopting evidence-informed response strategies, institutionalising the knowledge and relationships developed through prior events and improving evaluative processes (such as developing real-time monitoring capacity) will enable more effective response to future EHEs.

Conclusions
Western Washington’s health sector implemented EHE response activities that enabled essential service continuity, despite limited resources, unfamiliarity with EHEs and other systemic challenges. The recency of the heat dome presents an opportunity to incorporate lessons learnt into practice, policies, plans and built environment; these are necessary improvements ahead of future large-scale events the region may experience in the coming decades.

Objective
This study aimed to assess the status of infant and young child feeding (IYCF) practices and associated factors among children aged 0–23 months in the low-income regions of Dhaka City, Bangladesh.

Design
A community-based cross-sectional study.

Settings
Low-income regions of Dhaka City, Bangladesh.

Participants
530 children aged 0–23 months and their mothers.

Primary and secondary outcome measures
Prevailing IYCF practices were assessed against the 17 indicators of IYCF recommended by the WHO/UNICEF in 2021. Modified Poisson regression models were built to explore the relation between socio-demographic variables and each of the selected IYCF indicators (early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)).

Results
More than two-thirds of the children were reported to follow appropriate breastfeeding practices (EIBF, 70.4% and EBF, 60.9%). Among the complementary feeding indicators, almost half of the children (48.8%) were reported to meet MMF; however, only about 26% of the children reportedly met the MDD with a consequent low prevalence (22.9%) of the composite indicator MAD. More than half (55%) of the children were reported to consume egg and/or flesh food consumption; still, inappropriate dietary practices were observed among 60% had unhealthy food consumption, and 56% had zero vegetable or fruit consumption). Child age was a significant determinant of IYCF practices. The children of mothers with no pregnancy complications exhibited a greater chance of having EIBF (estimate: 1.21, 95% CI: 1.04, 1.42, p=0.02), MDD (Estimate: 1.67, 95% CI: 1.09, 2.55, p=0.02), and MAD (estimate: 1.70, 95% CI: 1.04, 2.77, p=0.03) compared with the children of mothers with pregnancy complications. The children with a mother having secondary or higher education had a higher chance of having MDD (estimate: 1.93, 95% CI: 1.35, 2.76, p=0.003) and MMF (estimate: 1.27, 95% CI: 1.03, 1.56, p=0.02) than the children of mothers having primary or no education. Similarly, children from higher-income households had a higher chance of getting MDD (estimate: 1.57, 95% CI: 1.07, 2.03, p=0.02), and MAD (estimate: 1.73, 95% CI: 1.14, 2.64, p=0.01) compared with children from lower-income households.

Conclusion
IYCF practices among a considerable proportion of children aged 0–23 months in the low-income regions of Dhaka City were found to be suboptimal and predicted by children’s age, maternal education and pregnancy complications, and household income.

Objectives
Using the Korea Health Panel 2021 survey data, we identify factors associated with health literacy (HL) among older adults aged 65 years and older.

Design
A secondary data analysis of the 2021 Korea Health Panel survey.

Setting
Korea Health Panel survey.

Participants
Data were from 3410 older adults greater double equals65 years of age, drawn from the 2016 registration census of the Korea Health Panel 2021 survey, with a stratified selection approach for participants.

Outcome measure
To explore the factors associated with HL within the framework of the Andersen behavioural model, considering predisposing factors (age, gender, region and spouse), enabling factors (National Basic Livelihood Security recipient, education level, economic activity, usual source of care) and need factors (subjective health status, usual activities, depression/anxiety and chronic disease).

Analysis
Stepwise multiple regression analysis was employed to examine the factors associated with HL among the study participants within the framework of the Andersen behavioural model.

Results
Statistically significant associations with HL were found for predisposition factors (age, gender and residential area), enabling factors (National Basic Livelihood Security recipient, educational background and usual source of care) and need factors (subjective health status, usual activities and the presence of chronic diseases). While the National Basic Livelihood Security recipient was significant in model 2 (p=0.011), it became nonsignificant in model 3 after adding need factors (p=0.093). Adding enabling factors to model 1 significantly increased the explanatory power (R2=0.084, p

Objectives
Using the Korea Health Panel 2021 survey data, we identify factors associated with health literacy (HL) among older adults aged 65 years and older.

Design
A secondary data analysis of the 2021 Korea Health Panel survey.

Setting
Korea Health Panel survey.

Participants
Data were from 3410 older adults greater double equals65 years of age, drawn from the 2016 registration census of the Korea Health Panel 2021 survey, with a stratified selection approach for participants.

Outcome measure
To explore the factors associated with HL within the framework of the Andersen behavioural model, considering predisposing factors (age, gender, region and spouse), enabling factors (National Basic Livelihood Security recipient, education level, economic activity, usual source of care) and need factors (subjective health status, usual activities, depression/anxiety and chronic disease).

Analysis
Stepwise multiple regression analysis was employed to examine the factors associated with HL among the study participants within the framework of the Andersen behavioural model.

Results
Statistically significant associations with HL were found for predisposition factors (age, gender and residential area), enabling factors (National Basic Livelihood Security recipient, educational background and usual source of care) and need factors (subjective health status, usual activities and the presence of chronic diseases). While the National Basic Livelihood Security recipient was significant in model 2 (p=0.011), it became nonsignificant in model 3 after adding need factors (p=0.093). Adding enabling factors to model 1 significantly increased the explanatory power (R2=0.084, p

Objective
This study aimed to assess the global, regional and national burden of pulmonary arterial hypertension (PAH) from 1990 to 2021 using data from the Global Burden of Disease Study 2021. The focus was on evaluating trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs) associated with PAH and examining these trends by age, gender and sociodemographic index (SDI).

Design
This is a systematic analysis leveraging data from the Global Burden of Disease Study 2021. The analysis focused on both crude and age-standardised rates to track temporal trends in PAH burden, with data stratified by region and SDI.

Setting
The study used global, regiona, and national data from 204 countries and regions, spanning from 1990 to 2021.

Participants
The participants in this study include individuals diagnosed with PAH, with data representing populations globally, categorised by age, gender and SDI.

Primary and secondary outcome measures
Primary outcome measures included global, regional and national incidence, prevalence, mortality and DALYs related to PAH. Secondary outcomes consisted of age-standardised rates (age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR)) and trends over the study period. A key strength of this study is the detailed stratification by SDI, revealing how PAH burden varies across different socio-economic settings. This extended temporal analysis offers new insights into long-term trends, highlighting the rising burden in lower-SDI regions and significant regional disparities in disease management and outcomes.

Results
From 1990 to 2021, global PAH cases showed substantial increases in both incidence (85.62%) and prevalence (81.46%), while age-standardised rates remained stable. Across SDI levels, high-SDI regions maintained stable ASIRs (0.37 per 100 000) with a slight decline (estimated average percentage change (EAPC) –0.06%), while low-SDI regions demonstrated the most significant reduction (EAPC –0.30%). Deaths increased by 48.36% globally, though the ASMR decreased from 0.35 to 0.27 per 100 000. The disease burden measured by DALYs decreased by 6.59%, with high-SDI regions showing better improvements in age-standardised DALY rates (–1.39% EAPC) compared with other SDI levels. Gender analysis revealed persistent female predominance (female-to-male ratio 1.62:1), particularly pronounced in populations over 50 years across all SDI quintiles.

Conclusions
While global age-standardised rates have declined, PAH remains a significant global health burden, particularly in low-SDI regions. These findings underscore the need for targeted prevention and intervention strategies, especially for high-risk populations, such as females and the elderly, to reduce the global health impact of PAH.

Objectives
Subarachnoid haemorrhage (SAH) is the third most prevalent subtype of stroke, representing a critical and potentially life-threatening cerebrovascular emergency. Given their large populations and diverse healthcare infrastructures, the BRICS (Brazil, Russian Federation, India, China and South Africa) nations play a pivotal role in the global SAH landscape. This investigation assesses the mortality trends of SAH in BRICS countries from 1982 to 2021.

Design and participants
This study uses data from the Global Burden of Disease (GBD) 2021 public dataset to investigate the temporal trends in SAH mortality over four decades globally and within BRICS countries. The age-period-cohort (APC) model was employed to estimate net drift, local drift, age-specific curves and period (cohort) relative risks.

Primary outcome measures
Mortality.

Results
From 1982 to 2021, there was a 3.85% increase in global SAH deaths and a 59.46% decrease in age-standardised mortality rates. SAH mortality rates are increasing across various age groups in BRICS countries, except in China and the Russian Federation, where most age groups show increasing trends. The annual net drift in SAH mortality varied from a decrease of 5.62% in China to an increase of 0.31% in the Russian Federation. Countries demonstrated similar age-effect patterns, with risk decreasing as age increased. However, period and cohort effects varied, suggesting different control measures and temporal mortality trends.

Conclusions
Changing patterns of mortality from SAH in the BRICS countries over the last four decades vary. We suggest using local resources to step up SAH prevention. Healthcare for all ages, especially the vulnerable, should improve to prevent and treat SAH better.

Stroke, Ahead of Print. BACKGROUND:The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States.METHODS:We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models.RESULTS:We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22–6.29), for Black patients was 7.12 (95% CI, 7.05–7.19), for Hispanic patients was 6.86 (95% CI, 6.76–6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18–7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings.CONCLUSIONS:In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.