Background: Previous research has found that uninsured and publicly insured elderly stroke patients have worse functional outcomes than those with private insurance. It is unknown if similar findings persist for young adults with stroke. We aimed to examine whether insurance status is associated with disability at discharge among young stroke patients. Methods: We conducted a retrospective analysis for stroke patients aged 18-49 years admitted to a single urban safety-net hospital from 2013-2025. Data included were stroke type (ischemic AIS, hemorrhagic ICH and subarachnoid hemorrhage SAH), vascular risk factors, insurance coverage, and modified Rankin Scale mRS scores pre-stroke and at hospital discharge. Health insurance status was classified as uninsured, public (Medicare and Medicaid), or private. Multivariable logistic regression analysis was used to relate health coverage to functional outcome (good mRS= 0-3 vs poor mRS= 4-6) using private insurance as reference. The model was adjusted for age, sex, pre-stroke mRS, type of stroke, and vascular risk factors. Results: Among 840 patients (median age 43 IQR 37–47, 43% women), 46% had public coverage, 43% had private, and 11% were uninsured. 65% had AIS, 21% ICH and 14% SAH. Hypertension (47%), smoking (23%), diabetes (19%), and dyslipidemia (15%) were the most prevalent vascular risk factors. 33% of patients had poor mRS at discharge. In the multivariable analysis, no insurance was associated with poor mRS (OR 1.67, 95% CI 1.00–2.78; p=0.05) as was public insurance (OR 1.49, 95% CI 1.06–2.08; p=0.02). After further adjustment for the three most prevalent vascular risk factors in our sample (hypertension, smoking, diabetes), the effect of public insurance (OR 1.53, 95% CI 1.09-2.15) and no insurance (OR 1.68, 95% CI 1.01-2.82) remained significant. Conclusions: In this safety-net cohort of young adults, both uninsured and publicly insured patients had higher disability at discharge after stroke than private insured patients. These findings highlight disparities linked to payor type in young stroke patients. Our findings also suggest that the association between insurance and disability at discharge is not explained by vascular risk factors alone. Future studies are needed to determine other biological factors of disability post-stroke, if this association persists across other stroke centers, and whether disability continues during long-term recovery.
Sisto et al. (Thu,) studied this question.