Brinjikji W, Rabinstein A A, McDonald J S, Cloft H J
From the Departments of Radiology (W.B., J.S.M., H.J.C.).
AJNR Am J Neuroradiol. 2014 Mar;35(3):553-6. doi: 10.3174/ajnr.A3708. Epub 2013 Aug 14.
Previous studies have demonstrated that socioeconomic disparities in the treatment of cerebrovascular diseases exist. We studied a large administrative data base to study disparities in the utilization of mechanical thrombectomy for acute ischemic stroke.
With the utilization of the Perspective data base, we studied disparities in mechanical thrombectomy utilization between patient race and insurance status in 1) all patients presenting with acute ischemic stroke and 2) patients presenting with acute ischemic stroke at centers that performed mechanical thrombectomy. We examined utilization rates of mechanical thrombectomy by race/ethnicity (white, black, and Hispanic) and insurance status (Medicare, Medicaid, self-pay, and private). Multivariate logistic regression analysis adjusting for potential confounding variables was performed to study the association between race/insurance status and mechanical thrombectomy utilization.
The overall mechanical thrombectomy utilization rate was 0.15% (371/249,336); utilization rate at centers that performed mechanical thrombectomy was 1.0% (371/35,376). In the sample of all patients with acute ischemic stroke, multivariate logistic regression analysis demonstrated that uninsured patients had significantly lower odds of mechanical thrombectomy utilization compared with privately insured patients (OR = 0.52, 95% CI = 0.25-0.95, P = .03), as did Medicare patients (OR = 0.53, 95% CI = 0.41-0.70, P < .0001). Blacks had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.35, 95% CI = 0.23-0.51, P < .0001). When considering only patients treated at centers performing mechanical thrombectomy, multivariate logistic regression analysis demonstrated that insurance was not associated with significant disparities in mechanical thrombectomy utilization; however, black patients had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.41, 95% CI = 0.27-0.60, P < .0001).
Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.
既往研究表明，脑血管疾病治疗中存在社会经济差异。我们研究了一个大型管理数据库，以探讨急性缺血性卒中机械取栓治疗利用方面的差异。
利用透视数据库，我们研究了1）所有急性缺血性卒中患者以及2）在进行机械取栓治疗的中心就诊的急性缺血性卒中患者中，患者种族与保险状况在机械取栓治疗利用方面的差异。我们按种族/族裔（白人、黑人及西班牙裔）和保险状况（医疗保险、医疗补助、自费及私人保险）检查了机械取栓治疗的利用率。进行多因素逻辑回归分析以校正潜在混杂变量，从而研究种族/保险状况与机械取栓治疗利用之间的关联。
总体机械取栓治疗利用率为0.15%（371/249,336）；在进行机械取栓治疗的中心，利用率为1.0%（371/35,376）。在所有急性缺血性卒中患者样本中，多因素逻辑回归分析表明，与私人保险患者相比，未参保患者接受机械取栓治疗的几率显著降低（比值比=0.52，95%可信区间=0.25-0.95，P=0.03），医疗保险患者也是如此（比值比=0.53，95%可信区间=0.41-0.70，P<0.0001）。与白人相比，黑人接受机械取栓治疗的几率显著降低（比值比=0.35，95%可信区间=0.23-0.51，P<0.0001）。仅考虑在进行机械取栓治疗的中心接受治疗的患者时，多因素逻辑回归分析表明，保险与机械取栓治疗利用方面的显著差异无关；然而，与白人相比，黑人接受机械取栓治疗的几率显著降低（比值比=0.41，95%可信区间=0.27-0.60，P<0.0001）。
在美国，机械取栓治疗的利用存在显著的社会经济差异。
