Association between educational attainment and discharge disposition following incident stroke hospitalization: the Atherosclerosis Risk in Communities study

Background: The relationship between educational attainment and discharge disposition after stroke hospitalization remains unclear. This study examined whether educational attainment is associated with discharge disposition after incident stroke and whether stroke severity modifies this association. Methods: The study included Atherosclerosis Risk in Communities (ARIC) participants with an incident stroke hospitalization from 1991 to 2020 who were enrolled in fee-for-service (FFS) Medicare at discharge. Discharge disposition was obtained from hospitalization claims. Educational attainment was categorized as "less than high school" vs. "high school or more." Multivariable logistic regression models were used to estimate associations between educational attainment and discharge disposition, adjusting for age at stroke, sex, race, and study center. Stroke severity was measured using the Stroke Administrative Severity Index (SASI) derived from Medicare discharge diagnosis codes and assessed as an effect modifier. Results: Among 976 stroke survivors (mean age 75.5 years; 56.6% women; 31.8% Black), the mean hospital stay was 9.3 days, and 30.1% had an intensive care unit (ICU) stay. Overall, 58.9% were discharged home. The median Elixhauser Comorbidity Index was 3, and 55.5% had a SASI score of zero. Compared with those with at least a high-school education, participants with less than high-school education had similar odds of being discharged home (AOR 0.95; 95% CI: 0.7-1.28). Stroke severity did not significantly modify the association. Conclusion: Educational attainment was not significantly associated with discharge disposition after incident stroke hospitalization in this cohort, although sample size limits the ability to rule out associations.