Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke
Racial and ethnic disparities in the access to mechanical thrombectomy (MT) for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion have been previously described. The effect of recent randomized trials validating MT as an effective therapy for AIS secondary to large vessel occlusion on such disparities has not been investigated.
Methods—
Information on admissions for AIS to endovascular centers occurring between January 2016 and September 2018 was obtained from a national database. The number of patients receiving IV-tPA (intravenous tissue-type plasminogen activator) and MT at each institution was determined, and patient demographics were characterized according to age, sex, race/ethnicity, and insurance status. Comparisons of patients who did and did not undergo MT and between patients of different racial and ethnic backgrounds were performed. Demographic variables independently associated with the utilization of MT were identified using multivariate linear regression analysis.
Results—
There were 206 853 admissions to 173 endovascular centers during the time period of interest. The overall utilization of MT was 8.4%. The utilization of MT for black/Hispanic patients was lower than that among white/non-Hispanic patients (7.0% versus 9.8%;
P
<0.001). Black/Hispanic patients were also less likely to receive IV-tPA (16.2% versus 20.5%;
P
<0.001) and to be admitted to the endovascular center after transfer from a different hospital (20.0% versus 30.1%;
P
<0.001). On multivariate linear regression analysis, increasing institutional proportions of patients with female sex (β=−0.601;
P
<0.001), insurance with Medicaid or uninsured status (β=−0.153;
P
=0.029), and black/Hispanic race/ethnicity (β=−0.062;
P
=0.046) were independently associated with lower institutional utilization of MT.
Conclusions—
Despite the mainstream acceptance of MT for the treatment of AIS secondary to large vessel occlusion, racial and ethnic disparities in the utilization of MT persist.
No keywords indexed for this article. Browse by subject →
Olvert A. Berkhemer, Puck S.S. Fransen, Debbie Beumer et al.
Bruce C.V. Campbell, Peter J. Mitchell, Timothy J. Kleinig et al.
Mayank Goyal, Andrew M. Demchuk, Bijoy K. Menon et al.
Jeffrey L. Saver, Mayank Goyal, Alain Bonafe et al.
Mayank Goyal, Bijoy K Menon, Wim H van Zwam et al.
Chen Hanna Ryder, Carmit Gal · 2024
Shelly Ikeme, Emilie Kottenmeier · 2022
Amytis Towfighi, Bruce Ovbiagele · 2022
Fred Stephen Sarfo, Bruce Ovbiagele · 2022
- Published
- Sep 01, 2019
- Vol/Issue
- 50(9)
- Pages
- 2428-2432
You May Also Like
H P Adams, B H Bendixen · 1993
10,102 citations
E Z Longa, P R Weinstein · 1989
6,226 citations
William J. Powers, Alejandro A. Rabinstein · 2019
5,762 citations
T Brott, H P Adams · 1989
4,385 citations
William J. Powers, Alejandro A. Rabinstein · 2018
4,245 citations