Racial Disparities in Stroke Care before and during COVID-19 in a Universal Health System: A Multiple-Group Interrupted Time-Series Analysis

BACKGROUND: The COVID-19 pandemic, marked by surges in healthcare demand and resource shortages, may exacerbated existing health disparities, particularly among marginalized racial groups. Black populations, in particular, often face reduced access to timely and quality care, worsening health outcomes. This study examines how a universal healthcare system responded to the pandemic and whether it mitigated racial disparities in stroke care. METHODS: Using a multiple-group interrupted time-series analysis, we analyzed panel data (2016 to 2021) from Colombia to assess the impact of the pandemic on stroke-related healthcare access, treatment duration, and mortality among Black and White populations. FINDINGS: Results showed that the Colombian healthcare system provided a protective effect for the White population. While healthcare access decreased for both groups during the pandemic, treatment durations differed. Black patients experienced a sharp increase in hospital stay duration immediately after the onset of COVID-19, followed by a steady decline of roughly 1% every two months. In contrast, White patients' treatment durations did not decline but instead continued to increase over time. Additionally, although pre-pandemic mortality rates were consistently higher among Black individuals, this disparity widened during the pandemic. While the White population saw a reduction in discharge mortality rates during the pandemic, the rates for Black individuals increased (3%). CONCLUSIONS: These findings demonstrate the limitations of universal health coverage in addressing racial disparities during crises. Policy responses should prioritize strengthening healthcare infrastructure in underserved areas and addressing implicit biases in care delivery to ensure equity during health crises.