Key result
Stroke Systems of Care legislation is linked to ~9 fewer stroke deaths per 100,000 statewide.
Why the study?
While Stroke Systems of Care laws reduce overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear.
Does the implementation of Stroke Systems of Care legislation reduce stroke mortality equitably across racial groups in Rhode Island?
Observational
Does the implementation of Stroke Systems of Care legislation reduce stroke mortality equitably across racial groups in Rhode Island?
While Stroke Systems of Care legislation reduced overall stroke mortality in Rhode Island, it exacerbated racial disparities, with Black populations experiencing increased mortality compared to White populations.
Answers are grounded in this paper and cite their sources.
SSOC laws reduced overall stroke mortality but not equitably by race; leaves open whether targeted refinements can close disparities in minorities.
Introduction: The Rhode Island Stroke Prevention and Treatment Act aimed to establish a standardised system of care for stroke patients through designated stroke centres, revise emergency medical services (EMS) protocols, and establish a centralised stroke database. While Stroke Systems of Care (SSOC) laws have proven effective in reducing overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear. This study investigates the impact of the Act and its amendment on stroke mortality rates across different racial groups. Methods: Data from the Rhode Island Department of Labor and Training, Centers for Disease Control Atlas of Heart Disease and Stroke, and US Census Bureau for 2006-2019 were analysed. A linear regression model analysed mortality rates among White, Black and Hispanic residents before and after the Act's implementation. Trends were further validated using a segmented regression and mixed-effects model. Results: Difference-in-differences analysis showed SSOC implementation reduced statewide all-stroke mortality by 8.56 deaths per 100 000 (95% CI -10.56 to -6.56; p<0.001). White and Hispanic groups declined, but the Black population diverged significantly from White (+20.80; 95% CI 4.83 to 36.77; p=0.011). Interrupted time series confirmed higher Black baseline mortality (β=9.70; 95% CI 2.00 to 17.40; p=0.014) and an abrupt post-implementation increase (β=29.14; 95% CI 16.64 to 41.63; p<0.001), followed by annual decline (β=-6.98; 95% CI -10.24 to -3.61; p<0.001). After amendment, Black mortality rose immediately (+19.80; 95% CI 2.15 to 37.44; p=0.028) and annually (+8.40; 95% CI 1.33 to 15.47; p=0.020). White and Hispanic groups showed no significant amendment-period changes. Conclusion: While SSOC significantly reduced overall stroke mortality in Rhode Island, the benefits were not equitably distributed across racial groups. These findings underscore the need for future stroke legislation to incorporate culturally competent, evidence-based strategies addressing social determinants of health to reduce disparities and ensure equitable care.
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A 2026 study conducted an observational in Stroke. Stroke Systems of Care (SSOC) implementation vs. Pre-implementation period was evaluated on Statewide all-stroke mortality (MD -8.56 deaths per 100,000, 95% CI -10.56 to -6.56, p=<0.001). Implementation of Stroke Systems of Care legislation in Rhode Island reduced statewide all-stroke mortality by 8.56 deaths per 100,000, but mortality increased among Black residents.
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