Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA.
Biostatistics, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
J Neurointerv Surg. 2023 Dec;15(12):1251-1256. doi: 10.1136/jnis-2022-019767. Epub 2023 Mar 2.
The literature suggests that minority racial and ethnic groups have lower treatment rates for unruptured intracranial aneurysms (UIA). It is uncertain how these disparities have changed over time.
A cross-sectional study using the National Inpatient Sample database covering 97% of the USA population was carried out.
A total of 213 350 treated patients with UIA were included in the final analysis and compared with 173 375 treated patients with aneurysmal subarachnoid hemorrhage (aSAH) over the years 2000-2019. The mean (SD) age of the UIA and aSAH groups was 56.8 (12.6) years and 54.3 (14.1) years, respectively. In the UIA group, 60.7% were white patients, 10.2% were black patients, 8.6% were Hispanic, 2% were Asian or Pacific Islander, 0.5% were Native Americans, and 2.8% were others. The aSAH group comprised 48.5% white patients, 13.6% black patients, 11.2% Hispanics, 3.6% Asian or Pacific Islanders, 0.4% Native Americans, and 3.7% others. After adjusting for covariates, black patients (OR 0.637, 95% CI 0.625 to 0.648) and Hispanic patients (OR 0.654, 95% CI 0.641 to 0.667) had lower odds of treatment compared with white patients. Medicare patients had higher odds of treatment than private patients, while Medicaid and uninsured patients had lower odds. Interaction analysis showed that non-white/Hispanic patients with any insurance/no insurance had lower treatment odds than white patients. Multivariable regression analysis showed that the treatment odds of black patients has improved slightly over time, while the odds for Hispanic patients and other minorities have remained the same over time.
This study from 2000 to 2019 shows that disparities in the treatment of UIA have persisted but have slightly improved over time for black patients while remaining constant for Hispanic patients and other minority groups.
文献表明，少数族裔人群颅内未破裂动脉瘤（UIA）的治疗率较低。目前尚不清楚这些差异随时间发生了怎样的变化。
本研究使用美国国家住院患者样本数据库（涵盖了美国 97%的人口）进行了一项横断面研究。
共纳入 2000 年至 2019 年期间 213350 例 UIA 治疗患者和 173375 例蛛网膜下腔出血（aSAH）治疗患者进行最终分析。UIA 组和 aSAH 组患者的平均（标准差）年龄分别为 56.8（12.6）岁和 54.3（14.1）岁。在 UIA 组中，60.7%为白人患者，10.2%为黑人患者，8.6%为西班牙裔，2%为亚洲或太平洋岛民，0.5%为美洲原住民，2.8%为其他族裔。aSAH 组包括 48.5%的白人患者，13.6%的黑人患者，11.2%的西班牙裔，3.6%的亚洲或太平洋岛民，0.4%的美洲原住民，3.7%的其他族裔。在校正协变量后，与白人患者相比，黑人患者（比值比 0.637，95%置信区间 0.625 至 0.648）和西班牙裔患者（比值比 0.654，95%置信区间 0.641 至 0.667）的治疗可能性较低。医疗保险患者的治疗可能性高于私人患者，而医疗补助和无保险患者的治疗可能性较低。交互分析显示，任何保险/无保险的非白人和西班牙裔患者的治疗可能性均低于白人患者。多变量回归分析显示，黑人患者的治疗可能性随时间略有改善，而西班牙裔患者和其他少数族裔患者的可能性则保持不变。
本研究从 2000 年至 2019 年表明，UIA 治疗方面的差异仍然存在，但黑人患者的差异随时间略有改善，而西班牙裔患者和其他少数族裔患者的差异则保持不变。
