社会经济差异对急性缺血性脑卒中机械取栓治疗的影响。
Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke.
机构信息
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Department of Neurology, Mayo Clinic, Rochester, Minnesota.
出版信息
J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):979-84. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.008. Epub 2013 Oct 8.
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.
背景
先前的研究表明，在获得脑血管疾病治疗方面存在社会经济差异。我们研究了全国住院患者样本（NIS），以确定在急性缺血性卒中机械取栓的应用中是否存在差异。
方法
我们使用 2006 年至 2010 年的 NIS，选择所有原发性急性缺血性卒中的出院患者。通过使用国际疾病分类，第九版，操作代码 39.74 来识别接受机械取栓治疗的卒中患者。我们通过种族/民族（白种人、黑种人、西班牙裔和亚洲/太平洋岛民）、收入四分位数（第一、第二至第三和第四）和保险状况（医疗保险、医疗补助、自付和私人）来检查机械取栓的使用率。我们还研究了进行取栓的医院的取栓使用率。
结果
2006 年至 2010 年，2087017 名患者因原发性急性缺血性卒中住院治疗；8946 名患者（0.4%）接受了机械取栓。与白人患者相比，黑人患者的总体机械取栓使用率明显较低（比值比 [OR] = 0.59，95%置信区间 [CI] = 0.55-0.64，P < 0.0001），在提供机械取栓的中心也较低（OR = 0.44，95%CI = 0.41-0.47，P < 0.0001）。与收入最高四分位数的患者相比，收入最低四分位数的患者的机械取栓使用率总体上较低（OR = 0.66，95%CI = 0.62-0.70，P < 0.0001），在提供机械取栓的中心也较低（OR = 0.80，95%CI = 0.75-0.84，P < 0.0001）。与私人保险患者相比，自付患者的机械取栓使用率总体上较低（OR = 0.71，95%CI = 0.64-0.78，P < 0.0001），在提供机械取栓的中心也较低（OR = 0.81，95%CI = 0.74-0.90，P < 0.0001）。
结论
在美国，机械取栓的应用存在显著的社会经济差异。
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