Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke

J Stroke Cerebrovasc Dis. May-Jun 2014;23(5):979-84. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.008. Epub 2013 Oct 8.

Abstract

Background: Previous studies have demonstrated that socioeconomic disparities in access to treatment of cerebrovascular diseases exist. We studied the Nationwide Inpatient Sample (NIS) to determine if disparities exist in utilization of mechanical thrombectomy for acute ischemic stroke.

Methods: Using the NIS for the years 2006-2010, we selected all discharges with a primary diagnosis of acute ischemic stroke. Patients who received mechanical thrombectomy for stroke were identified by using the International Classification of Diseases, Ninth Revision, procedure code 39.74. We examined the utilization rates of mechanical thrombectomy by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander), income quartile (first, second to third, and fourth), and insurance status (Medicare, Medicaid, self-pay, and private). We also studied thrombectomy utilization rates at hospitals that performed thrombectomy.

Results: From 2006 to 2010, 2,087,017 patients were hospitalized with a primary diagnosis of acute ischemic stroke; 8946 patients (.4%) received mechanical thrombectomy. Compared with white patients, black patients had significantly lower rates of overall mechanical thrombectomy utilization (odds ratio [OR] = .59, 95% confidence interval [CI] = .55-.64, P < .0001) and at centers that offered mechanical thrombectomy (OR = .44, 95% CI = .41-.47, P < .0001). Compared with patients in the highest income quartile, patients in the lowest income quartile had significantly lower rates of mechanical thrombectomy utilization both overall (OR = .66, 95% CI = .62-.70, P < .0001) and at centers that offered mechanical thrombectomy (OR = .80, 95% CI = .75-.84, P < .0001). Compared with patients with private insurance, self-pay patients had significantly lower mechanical thrombectomy utilization both overall (OR = .71, 95% CI = .64-.78, P < .0001) and at centers that offered mechanical thrombectomy (OR = .81, 95% CI = .74-.90, P < .0001).

Conclusions: Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.

Keywords: Mechanical thrombectomy; acute ischemic stroke; epidemiology; socioeconomics.

Publication types

  • Comparative Study

MeSH terms

  • Brain Ischemia / diagnosis
  • Brain Ischemia / economics*
  • Brain Ischemia / ethnology
  • Brain Ischemia / therapy*
  • Chi-Square Distribution
  • Continental Population Groups
  • Ethnic Groups
  • Health Services Accessibility / economics*
  • Healthcare Disparities / economics*
  • Healthcare Disparities / ethnology
  • Humans
  • Income
  • Insurance Coverage / economics
  • Insurance, Health / economics
  • Logistic Models
  • Multivariate Analysis
  • Odds Ratio
  • Practice Patterns, Physicians' / economics
  • Risk Factors
  • Socioeconomic Factors*
  • Stroke / diagnosis
  • Stroke / economics*
  • Stroke / ethnology
  • Stroke / therapy*
  • Thrombectomy / economics*
  • Thrombectomy / statistics & numerical data*
  • Treatment Outcome
  • United States / epidemiology