Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):327-34. doi: 10.1016/j.jstrokecerebrovasdis.2013.03.036. Epub 2013 May 13.
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.
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.
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.
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.
近年来，用于治疗急性缺血性脑卒中的机械再通术有所增加。数据表明手术量与死亡率之间存在关联。了解手术分配和患者就诊模式至关重要。很少有研究检查这些人口统计学数据。
数据来自 2008 年全国住院患者样本数据库。患有缺血性脑卒中的患者和接受机械血栓切除术的患者亚组的特征包括种族、付款来源、人口密度和患者邮政编码的中位财富。检查接受机械血栓切除术患者的人口统计学数据。根据接受中心的机械血栓切除术量分析脑卒中入院人口统计学数据，并根据治疗中心的机械血栓切除术量评估患者人口统计学数据。
根据种族、预期付款人、人口密度和患者邮政编码的财富，缺血性脑卒中患者接受机械血栓切除术的频率存在显著的分配差异（P<0.0001）。白种人、西班牙裔和亚洲/太平洋岛民患者接受血管内治疗的比例高于黑人和美国原住民患者。与白人脑卒中患者相比，黑人（P<0.001）、西班牙裔（P<0.001）、亚洲/太平洋岛民（P<0.001）和美国原住民脑卒中患者（P<0.001）接受机械血栓切除术的频率均降低。在接受治疗的患者中，与白人相比，黑人（P=0.0876）、西班牙裔（P=0.0335）和亚洲/太平洋岛民（P<0.001）在高容量中心接受机械血栓切除术的频率降低。尽管存在，但社会经济差异并不像种族差异那样一致或明显。
我们在 2008 年根据种族和社会经济因素展示了血管内急性脑卒中治疗分配的差异。应努力监测和解决潜在的治疗利用差异。
