Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
J Neurointerv Surg. 2019 Aug;11(8):833-836. doi: 10.1136/neurintsurg-2018-014626. Epub 2019 Jan 23.
Previous studies have documented disparate access to cerebrovascular neurosurgery for patients of different racial and socioeconomic backgrounds. We further investigated the effect of race and insurance status on access to treatment of unruptured intracranial aneurysms (UIAs) and compared it with data on patients with aneurysmal subarachnoid hemorrhage (aSAH).
Through the use of a national database, admissions for clipping or coiling of an UIA and for aSAH were identified. Demographic characteristics of patients were characterized according to age, sex, race/ethnicity, and insurance status, and comparisons between patients admitted for treatment of an UIA versus aSAH were performed.
There were 10 545 admissions for clipping or coiling of an UIA and 33 166 admissions for aSAH between October 2014 and July 2018. White/non-Hispanic patients made up a greater proportion of patients presenting for treatment of an UIA than those presenting with aSAH (64.3% vs 48.2%; P<0.001), whereas black/Hispanic patients presented more frequently with aSAH than for treatment of an UIA (29.3% vs 26.1%; P=0.006). On multivariate linear regression analysis, the proportion of patients admitted for management of an UIA relative to those admitted for aSAH increased with the proportion of patients who were women (P<0.001) and decreased with the proportion of patients with a black/Hispanic background (P=0.010) and those insured with Medicaid or without insurance (P=0.003).
For patients with UIAs, racial, ethnic, and socioeconomic backgrounds appear to continue to influence access to treatment.
先前的研究记录了不同种族和社会经济背景的患者获得脑血管神经外科治疗的机会存在差异。我们进一步调查了种族和保险状况对未破裂颅内动脉瘤（UIAs）治疗机会的影响，并将其与动脉瘤性蛛网膜下腔出血（aSAH）患者的数据进行了比较。
通过使用国家数据库，确定了夹闭或血管内栓塞治疗 UIAs 和 aSAH 的入院病例。根据年龄、性别、种族/民族和保险状况对患者的人口统计学特征进行了描述，并对接受 UIAs 治疗和 aSAH 治疗的患者进行了比较。
2014 年 10 月至 2018 年 7 月期间，有 10545 例患者接受夹闭或血管内栓塞治疗 UIAs，33166 例患者接受 aSAH 治疗。白人/非西班牙裔患者接受 UIAs 治疗的比例高于 aSAH 治疗（64.3% vs. 48.2%；P<0.001），而黑人和西班牙裔患者接受 aSAH 治疗的比例高于 UIAs 治疗（29.3% vs. 26.1%；P=0.006）。多元线性回归分析显示，接受 UIAs 治疗的患者比例相对于接受 aSAH 治疗的患者比例随着女性患者比例的增加而增加（P<0.001），随着黑人和西班牙裔患者比例的增加而降低（P=0.010），以及随着 Medicaid 保险或无保险患者比例的增加而降低（P=0.003）。
对于 UIAs 患者，种族、民族和社会经济背景似乎继续影响治疗机会。
