Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
Acad Emerg Med. 2023 Sep;30(9):918-926. doi: 10.1111/acem.14731. Epub 2023 Apr 21.
Acute ischemic stroke is a major health burden worldwide and mechanical thrombectomy is the treatment of choice for large-vessel occlusion stroke. This study aimed to evaluate the association between neighborhood socioeconomic status (SES) and the likelihood of receiving mechanical thrombectomy in patients with acute ischemic stroke.
A nationwide cross-sectional study was conducted using the National Emergency Department Information System database. Patients who were diagnosed with ischemic stroke in the emergency department (ED) within 24 h of symptom onset between 2018 and 2021 were included. The neighborhood SES index was measured at the county level using property tax per capita, education level, and the proportions of single families and single-parent households. The study population was divided into quartiles based on the neighborhood SES index. The study outcome was mechanical thrombectomy. Multilevel multivariable logistic regression was performed. An interaction analysis between mental status at the ED triage and neighborhood SES was also performed.
Among the 196,007 patients, 8968 (4.6%) underwent mechanical thrombectomy. Compared with the affluent group, the deprived-middle and deprived groups were less likely to receive mechanical thrombectomy; the adjusted ORs (95% CIs) were 1.00 (0.92-1.09), 0.82 (0.74-0.91), and 0.82 (0.72-0.93) for the affluent-middle, deprived-middle, and deprived groups, respectively. Altered mental status at the ED triage strengthened the association between neighborhood SES and the likelihood of receiving mechanical thrombectomy (adjusted ORs [95% CIs] 0.85 [0.81-0.89] for the affluent-middle to deprived-middle group and 0.66 [0.65-0.66] for deprived groups, p-value for interaction < 0.05).
For patients diagnosed with acute ischemic stroke at the ED, low neighborhood SES is associated with low odds of receiving mechanical thrombectomy. Public health strategies should be developed to resolve these disparities and to decrease the health care burden of acute ischemic stroke.
急性缺血性脑卒中是全球范围内的一个主要健康负担，机械取栓是治疗大血管闭塞性脑卒中的首选方法。本研究旨在评估社区社会经济地位（SES）与急性缺血性脑卒中患者接受机械取栓治疗的可能性之间的关联。
本研究使用全国性的横断面研究，利用国家急救部门信息系统数据库，纳入了 2018 年至 2021 年期间症状发作后 24 小时内被诊断为缺血性脑卒中的急诊患者。使用人均财产税、教育水平以及单身家庭和单亲家庭的比例来衡量县一级的社区 SES 指数。根据社区 SES 指数将研究人群分为四等份。研究结局为机械取栓。采用多水平多变量逻辑回归进行分析。还对 ED 分诊时的精神状态与社区 SES 之间的交互作用进行了分析。
在 196007 名患者中，有 8968 名（4.6%）接受了机械取栓治疗。与富裕组相比，中等贫困和贫困组接受机械取栓治疗的可能性较低；调整后的比值比（95%置信区间）分别为 1.00（0.92-1.09）、0.82（0.74-0.91）和 0.82（0.72-0.93）。ED 分诊时的精神状态改变增强了社区 SES 与接受机械取栓治疗的可能性之间的关联（调整后的比值比[95%置信区间]，富裕-中等贫困组为 0.85[0.81-0.89]，贫困组为 0.66[0.65-0.66]，交互作用的 p 值<0.05）。
对于在 ED 诊断为急性缺血性脑卒中的患者，低社区 SES 与接受机械取栓治疗的可能性较低相关。应制定公共卫生策略来解决这些差异，降低急性缺血性脑卒中的医疗负担。
