Frank J Attenello1, Peter Adamczyk2, Ge Wen3, Shuhan He2, Katie Zhang2, Jonathan J Russin2, Nerses Sanossian2, Arun P Amar2, William J Mack2. 1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: attenell@usc.edu. 2. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. 3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Abstract
BACKGROUND: Mechanical revascularization procedures performed for treatment of acute ischemic stroke have increased in recent years. Data suggest association between operative volume and mortality rates. Understanding procedural allocation and patient access patterns is critical. Few studies have examined these demographics. METHODS: Data were collected from the 2008 Nationwide Inpatient Sample database. Patients hospitalized with ischemic stroke and the subset of individuals who underwent mechanical thrombectomy were characterized by race, payer source, population density, and median wealth of the patient's zip code. Demographic data among patients undergoing mechanical thrombectomy procedures were examined. Stroke admission demographics were analyzed according to thrombectomy volume at admitting centers and patient demographics assessed according to the thrombectomy volume at treating centers. RESULTS: Significant allocation differences with respect to frequency of mechanical thrombectomy procedures among stroke patients existed according to race, expected payer, population density, and wealth of the patient's zip code (P < .0001). White, Hispanic, and Asian/Pacific Islander patients received endovascular treatment at higher rates than black and Native American patients. Compared with the white stroke patients, black (P < .001), Hispanic (P < .001), Asian/Pacific Islander (P < .001), and Native American stroke patients (P < .001) all demonstrated decreased frequency of admission to hospitals performing mechanical thrombectomy procedures at high volumes. Among treated patients, blacks (P = .0876), Hispanics (P = .0335), and Asian/Pacific Islanders (P < .001) demonstrated decreased frequency in mechanical thrombectomy procedures performed at high-volume centers when compared with whites. While present, socioeconomic disparities were not as consistent or pronounced as racial differences. CONCLUSIONS: We demonstrate variances in endovascular acute stroke treatment allocation according to racial and socioeconomic factors in 2008. Efforts should be made to monitor and address potential disparities in treatment utilization. Published by Elsevier Inc.
BACKGROUND: Mechanical revascularization procedures performed for treatment of acute ischemic stroke have increased in recent years. Data suggest association between operative volume and mortality rates. Understanding procedural allocation and patient access patterns is critical. Few studies have examined these demographics. METHODS: Data were collected from the 2008 Nationwide Inpatient Sample database. Patients hospitalized with ischemic stroke and the subset of individuals who underwent mechanical thrombectomy were characterized by race, payer source, population density, and median wealth of the patient's zip code. Demographic data among patients undergoing mechanical thrombectomy procedures were examined. Stroke admission demographics were analyzed according to thrombectomy volume at admitting centers and patient demographics assessed according to the thrombectomy volume at treating centers. RESULTS: Significant allocation differences with respect to frequency of mechanical thrombectomy procedures among strokepatients existed according to race, expected payer, population density, and wealth of the patient's zip code (P < .0001). White, Hispanic, and Asian/Pacific Islander patients received endovascular treatment at higher rates than black and Native American patients. Compared with the white strokepatients, black (P < .001), Hispanic (P < .001), Asian/Pacific Islander (P < .001), and Native American strokepatients (P < .001) all demonstrated decreased frequency of admission to hospitals performing mechanical thrombectomy procedures at high volumes. Among treated patients, blacks (P = .0876), Hispanics (P = .0335), and Asian/Pacific Islanders (P < .001) demonstrated decreased frequency in mechanical thrombectomy procedures performed at high-volume centers when compared with whites. While present, socioeconomic disparities were not as consistent or pronounced as racial differences. CONCLUSIONS: We demonstrate variances in endovascular acute stroke treatment allocation according to racial and socioeconomic factors in 2008. Efforts should be made to monitor and address potential disparities in treatment utilization. Published by Elsevier Inc.
Authors: George Howard; Ron Prineas; Claudia Moy; Mary Cushman; Martha Kellum; Ella Temple; Andra Graham; Virginia Howard Journal: Stroke Date: 2006-03-23 Impact factor: 7.914
Authors: Peter Adamczyk; Frank Attenello; Ge Wen; Shuhan He; Jonathan Russin; Nerses Sanossian; Arun Paul Amar; William J Mack Journal: J Stroke Cerebrovasc Dis Date: 2012-09-25 Impact factor: 2.136
Authors: Lee H Schwamm; Mathew J Reeves; Wenqin Pan; Eric E Smith; Michael R Frankel; DaiWai Olson; Xin Zhao; Eric Peterson; Gregg C Fonarow Journal: Circulation Date: 2010-03-22 Impact factor: 29.690
Authors: Halina White; Bernadette Boden-Albala; Cuiling Wang; Mitchell S V Elkind; Tanja Rundek; Clinton B Wright; Ralph L Sacco Journal: Circulation Date: 2005-03-15 Impact factor: 29.690
Authors: Hormuzdiyar H Dasenbrock; Faith C Robertson; M Ali Aziz-Sultan; Donovan Guittieres; Rose Du; Ian F Dunn; William B Gormley Journal: Neurocrit Care Date: 2016-12 Impact factor: 3.210
Authors: Adam de Havenon; Kevin Sheth; Karen C Johnston; Alen Delic; Eric Stulberg; Jennifer Majersik; Mohammad Anadani; Shadi Yaghi; David Tirschwell; John Ney Journal: Neurology Date: 2021-10-14 Impact factor: 9.910
Authors: Stephanie G Thompson; P Alan Barber; John H Gommans; Dominique A Cadilhac; Alan Davis; John N Fink; Matire Harwood; William Levack; Harry McNaughton; Valery L Feigin; Virginia Abernethy; Jackie Girvan; Hayley Denison; Marine Corbin; Andrew Wilson; Jeroen Douwes; Annemarei Ranta Journal: Lancet Reg Health West Pac Date: 2022-01-03
Authors: Toby I Gropen; Nataliya V Ivankova; Mark Beasley; Erik P Hess; Brian Mittman; Melissa Gazi; Michael Minor; William Crawford; Alice B Floyd; Gary L Varner; Michael J Lyerly; Camella C Shoemaker; Jackie Owens; Kent Wilson; Jamie Gray; Shaila Kamal Journal: Front Neurol Date: 2021-12-06 Impact factor: 4.003
Authors: Sushanth Rao Aroor; Kaiz S Asif; Jennifer Potter-Vig; Arun Sharma; Bijoy K Menon; Violiza Inoa; Cynthia B Zevallos; Jose G Romano; Santiago Ortega-Gutierrez; Larry B Goldstein; Dileep R Yavagal Journal: J Stroke Date: 2022-01-31 Impact factor: 6.967
Authors: Kori S Zachrison; Margaret E Samuels-Kalow; Sijia Li; Zhiyu Yan; Mathew J Reeves; Renee Y Hsia; Lee H Schwamm; Carlos A Camargo Journal: J Am Coll Emerg Physicians Open Date: 2022-03-14