Three new studies shared this week at the Society of NeuroInterventional Surgery (SNIS) 23rd Annual Meeting deliver a clear message: stroke care in the U.S. is improving, but those gains are not reaching everyone equally. Researchers found persistent disparities tied to race, geography, and socioeconomic status—factors that can shape whether a patient receives advanced treatment, how quickly they reach specialized care, and ultimately, whether they survive.

Stroke remains one of the nation’s leading causes of death and long-term disability. In recent years, breakthroughs in emergency response systems and minimally invasive procedures have expanded what’s possible in the critical first hours after a stroke. But the latest findings suggest that access to those life-saving advances still depends too heavily on who you are and where you live.

Study 1: Treatment gaps widen as strokes get more severe

The first study, “Racial Disparities in Endovascular Thrombectomy Widen with Stroke Severity: A National Inpatient Sample Analysis,” examined more than 325,000 acute ischemic stroke patients treated at U.S. teaching hospitals between 2018 and 2022.

The focus was endovascular thrombectomy (EVT), a minimally invasive procedure in which specialists remove a clot from a blocked artery in the brain. EVT can be a game-changer for eligible patients—but researchers found Black patients were less likely than white patients to receive it across all levels of stroke severity.

What stood out most: the disparity grew as stroke severity increased. At a National Institutes of Health Stroke Scale (NIHSS) score of 20, the predicted probability of receiving EVT was:

• 33% for white men
• 32% for white women
• 28% for Black men
• 26% for Black women

Co-first author Muhammed Amir Essibayi, MD, MSc, FRCP, noted that timely access becomes even more critical as severity rises—yet the treatment gap becomes more pronounced. The study also highlighted an intersectional pattern, with Black women consistently least likely to receive EVT.

Study 2: Hemorrhagic stroke deaths are falling—but disparities persist

The second study, “Reducing Inequalities in Stroke Events-Hemorrhagic Disparities (RISE-HD): A 10-year Statewide Analysis of Social Determinants of Mortality in Hemorrhagic Stroke,” analyzed more than 120,000 patients hospitalized with hemorrhagic stroke in Florida between 2013 and 2024.

There was good news: mortality rates declined significantly over the decade, suggesting real progress in stroke systems and hospital care.

But after adjusting for age, sex, and comorbidities, disparities remained. Black patients had higher odds of in-hospital mortality than white patients. Higher mortality was also associated with:

• Living in rural areas
• Having Medicaid or other non-commercial insurance

Researchers also found regional differences across Florida, pointing to uneven access to specialized stroke care.

Primary author Natália Vasconcellos, MD, MSc, emphasized that improving outcomes for everyone will require addressing barriers to specialized stroke systems—especially in underserved communities.

Study 3: The “Stroke Belt” has two different access problems

The third study, “Dual Pathways to Hemorrhagic Stroke Mortality Across the U.S. Stroke Belt: Rural Neurointerventional Isolation and Urban Structural Vulnerability,” looked at hemorrhagic stroke mortality across 433 counties in the “Stroke Belt,” a region long associated with higher stroke rates and worse outcomes.

Researchers compared factors linked to mortality in rural versus urban counties, including:

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• Distance to the nearest Comprehensive Stroke Center
• Community-level socioeconomic disadvantage
• Racial and economic segregation
• HIV burden

They found the drivers of mortality differed sharply by setting:

• In rural counties, longer travel times to Comprehensive Stroke Centers were more strongly associated with higher mortality.
• In urban counties, racialized economic segregation and HIV burden were more strongly associated with poorer outcomes—even when specialized care was geographically closer.

Dylan Yates, a medical student at Tulane University School of Medicine, summarized the takeaway: the neurointerventional access gap in the Stroke Belt is “not one problem, it is two.” Solutions need to match the reality on the ground—strengthening transfer networks and specialty connections in rural areas, while addressing structural disadvantage and underinvestment in urban communities.

What to watch for: where the system can improve

Across all three studies, the common thread is that medical innovation alone doesn’t guarantee equitable outcomes. Researchers pointed toward targeted interventions that could help close the gap, including:

• More consistent, equitable treatment pathways for advanced stroke procedures like EVT
• Stronger stroke transfer networks to reduce delays—especially in rural regions
• Expanded access to specialty stroke care and Comprehensive Stroke Centers
• Community-level investment and structural reforms in underserved urban neighborhoods

For patients and families, these findings also reinforce the importance of recognizing stroke symptoms quickly and calling 911 immediately. Time is brain—yet the system must ensure that “time” and “access” don’t vary based on race, ZIP code, or insurance status.Source: Society of NeuroInterventional Surgery (SNIS), July 

Related Links

• Society of NeuroInterventional Surgery (SNIS) — https://www.snisonline.org
• NIH: Stroke (overview, symptoms, treatment) — https://www.ninds.nih.gov/health-information/disorders/stroke
• CDC: Stroke (risk factors, prevention, data) — https://www.cdc.gov/stroke/
• American Stroke Association (ASA): Stroke resources — https://www.stroke.org/
• NIH Stroke Scale (NIHSS) basics (clinical context) — https://www.stroke.nih.gov/resources/scale.htm
• Find a certified stroke center (The Joint Commission) — https://www.qualitycheck.org/

SOURCE Society of NeuroInterventional Surgery

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If You’re Feeling Stressed by Pricey Meds, Pharmacists Can Help

(Feature Impact) If your wallet is feeling the squeeze of prescription drug costs as other living expenses like grocery and energy prices rise, you’re not alone.

More people are worrying about affording essential medications these days. In fact, more than 40% of adults said they skipped doses or didn’t fill prescriptions in the past year due to cost, according to a KFF Health survey.

People who take multiple drugs to manage chronic conditions often feel this pinch even more severely. They’re also more likely to make more frequent visits to their clinic or health system for care. That’s where a powerful ally can help them manage their drug costs: a health-system pharmacist.

These medication experts work side-by-side with the clinicians who prescribe drugs in health care practices – and sometimes prescribe medications themselves. Their deep knowledge can help people get the most out of the drugs they take.

“Pharmacists really know the full picture of medications, including pricing, insurance coverage, alternative therapies and potential side effects,” said Lindsey Amerine, PharmD, chief pharmacy officer for the Cleveland Clinic. “That’s why it’s helpful to not only count on your doctor to diagnose your condition and prescribe therapies, but also your pharmacist to optimize your medications.”

Get a Comprehensive Review of Your Medications

Asking the pharmacist on your health-system care team to go over your medications may reveal opportunities to save, Amerine said. Health-system pharmacists are uniquely qualified to provide this service because they keep close track of medication costs as well as approvals of new drugs and how those compare to older options.

A full review might reveal:

• Drugs once needed may not be as useful anymore. People often continue taking medications unaware that something new could offer greater benefits or their condition no longer requires the same therapy.
• Changes in your condition may mean you could safely take a lower dosage of a drug, thereby reducing costs.
• There may be less costly alternatives that would work as well such as a generic or older medication.

Get Help Exploring Discount Options

You’ve probably heard about programs that can help lower prescription costs, including discount and patient assistance programs. Pharmacists can help you understand how to navigate these programs and access potential discount programs and opportunities, Amerine said. Here’s how:

• Pharmacists can guide you through discount programs your health system offers.
• They can check your eligibility for drug maker discounts and help you understand how those discounts work with your insurance, especially if you have a high-deductible plan.
• Pharmacists can help you navigate the various prescription cost-savings programs and how they work.
• They can also help you learn about patient assistance programs that provide free or discounted medications to people who cannot afford them.

Medications are a vital part of your health care. Before you try to stretch a costly medicine or give it up altogether, talk to the medication expert on your health care team: your health-system pharmacist. For more information, visit yourpharmacist.org. 

Why It Pays to Talk Meds with a Pharmacist

“My doctor prescribed it, so I must need it.” Often this is true, but not always. People sometimes take drugs longer than they need to, at doses higher than necessary or that may interact with other medications.

Just as you’d see a heart specialist about an odd pulse rate, it can help to see a pharmacist – your medication specialist – to discuss your prescriptions.

Of all health care professionals, pharmacists have the deepest knowledge of drug interactions and safety issues. They’re experts on how the effectiveness of different medications – brand name and generic – compare. They also closely track changes in prices and know when a drug’s cost has dropped or if an effective, less costly alternative is available.

Health-system pharmacists’ expertise is especially helpful for those with multiple chronic conditions who typically take several medications with more benefits, costs and side effects to balance.

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Talking with a pharmacist can ensure your prescriptions are best for you and that you have access to the most affordable options.

SOURCE:

American Society of Health-System Pharmacists

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Over the past decade, vaping has become a common alternative to traditional cigarette smoking. While many people view e-cigarettes as a “healthier” option, the reality is more complicated. Experts generally agree that vaping exposes users to fewer harmful chemicals than burning tobacco, but that doesn’t mean it’s risk-free.

Unlike traditional cigarettes, vaping devices heat a liquid—often containing nicotine, flavorings, and other chemicals—into an aerosol that users inhale. Because there is no combustion, vaping eliminates many of the toxic substances produced by cigarette smoke, including tar and carbon monoxide. However, users are still exposed to potentially harmful chemicals and ultrafine particles that can affect the lungs and cardiovascular system.

Known Health Risks

Research has linked vaping to several potential health concerns, including:

• Nicotine addiction
• Increased heart rate and blood pressure
• Lung irritation, coughing, and wheezing
• Exposure to chemicals such as formaldehyde and heavy metals
• Possible long-term effects on heart and lung health that are still being studied

In addition, nicotine can affect brain development in adolescents and young adults, making vaping especially concerning for younger users.

Is It Better Than Smoking?

For adults who already smoke cigarettes, many public health experts believe that completely switching to regulated nicotine vaping products is likely less harmful than continuing to smoke traditional cigarettes. That’s because cigarette smoke contains thousands of chemicals, including dozens known to cause cancer.

However, vaping is not considered safe. The greatest health benefits come from quitting nicotine altogether. People who both vape and continue smoking cigarettes may see little reduction in health risks.

Common Side Effects

Some people who vape report:

• Dry mouth
• Sore throat
• Coughing
• Headaches
• Dizziness
• Nausea
• Sleep disturbances related to nicotine

The Bottom Line

If you don’t smoke, health experts recommend that you don’t start vaping. For smokers trying to quit, vaping may reduce exposure to many of the harmful chemicals found in cigarettes—but it should be viewed as a potential harm-reduction tool rather than a harmless habit.

Whether you smoke, vape, or are trying to quit, talking with your healthcare provider about evidence-based smoking cessation options can help you find the approach that’s right for you.

Your health is worth investing in—every step away from tobacco is a step toward a healthier future.

Related Links

• FDA — E-Cigarettes, Vapes and Other Electronic Nicotine Delivery Systems — Information about e-cigarettes and vaping products regulated by the U.S. Food and Drug Administration.
• Smokefree.gov — What We Know About Electronic Cigarettes — National Cancer Institute information about vaping, nicotine, potential health risks, and smoking cessation.
• American Lung Association — E-Cigarettes and Vaping — Resources covering vaping’s potential effects on lung health and nicotine addiction.
• American Lung Association — E-Cigarettes and Lung Health — A closer look at what researchers know about vaping and lung health.
• Smokefree.gov — Quit Vaping Resources — Practical information for people who want to stop vaping, including managing cravings and nicotine withdrawal.

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