Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Clin Neurol Neurosurg. 2024 Dec;247:108638. doi: 10.1016/j.clineuro.2024.108638. Epub 2024 Nov 10.
Stroke remains a leading cause of morbidity and mortality worldwide. Socioeconomic disparities significantly affect the treatment and outcomes of cardiovascular and cerebrovascular diseases, including acute ischemic stroke. This study examines patients treated at Thomas Jefferson University Hospital, with ZIP code-based socioeconomic data predominantly representing areas in Pennsylvania and New Jersey, as the majority of patients originate from these regions.
This study is a retrospective analysis based on a prospectively maintained database of 697 patients who underwent mechanical thrombectomy between 2016 and 2023. ZIP codes were retrospectively added to the database to determine socioeconomic status (SES). SES was assessed by matching patient ZIP codes to median household income data from the Census for the years 2016-2022. Baseline characteristics, stroke characteristics, procedural details, and outcomes were collected. Patients were stratified into income quintiles (Q1: $14,658-$52,635; Q2: $52,905-$64,046; Q3: $64,140-$77,737; Q4: $78,449-$95,128; Q5: $95,231-$217,674). Multivariate regression was conducted to identify predictors of good functional outcomes (mRS 0-2).
The study included 697 patients representing 270 zip codes distributed across income quintiles as follows: Q1 (n = 140), Q2 (n = 142), Q3 (n = 138), Q4 (n = 138), and Q5 (n = 139). Significant racial differences were observed between income quintiles, with a higher proportion of African-American patients in Q1 (40.7 %) compared to Q5 (19.9 %; p < 0.001), and more white patients in Q5 (82.7 %) compared to Q1 (47.1 %; p < 0.001). The Onset to arterial puncture time was longer in Q1 (369 min) compared to Q5 (258 min; p = 0.004). There were no significant differences in stroke outcomes such as successful recanalization (TICI 2b-3), hemorrhagic transformation, median NIHSS score on discharge, 30-day readmission, disposition to home, or length of stay between Q1 and Q5. SES was not a significant predictor of good functional outcomes (mRS 0-2).
This study found no significant differences in stroke outcomes between low SES and high SES patients undergoing mechanical thrombectomy for acute ischemic stroke. Patients from higher SES had a shorter duration from stroke onset to arterial puncture, and there was a tendency though not significant for higher SES patients to have a higher rate of 30-day readmission, and higher rate of discharge to home. Further research is needed to confirm.
中风仍然是全球发病率和死亡率的主要原因。社会经济差距显著影响心血管和脑血管疾病的治疗和结果，包括急性缺血性中风。本研究检查了在托马斯杰斐逊大学医院接受治疗的患者，这些患者的邮政编码主要代表宾夕法尼亚州和新泽西州的地区，因为大多数患者来自这些地区。
这是一项基于 2016 年至 2023 年间接受机械血栓切除术的 697 名患者的前瞻性维护数据库的回顾性分析。将邮政编码追溯添加到数据库中，以确定社会经济地位（SES）。SES 通过将患者的邮政编码与 2016-2022 年人口普查的家庭中位数收入数据相匹配来评估。收集了基线特征、中风特征、手术细节和结果。患者分为收入五分位数（Q1：$14,658-52,635；Q2：$52,905-64,046；Q3：$64,140-77,737；Q4：$78,449-95,128；Q5：$95,231-217,674）。进行多变量回归以确定良好功能结果（mRS 0-2）的预测因素。
该研究包括代表分布在收入五分位数的 270 个邮政编码的 697 名患者，如下所示：Q1（n=140）、Q2（n=142）、Q3（n=138）、Q4（n=138）和 Q5（n=139）。在收入五分位数之间观察到显著的种族差异，与 Q5（19.9%）相比，Q1（40.7%）中非洲裔美国人的比例更高（p<0.001），而 Q5（82.7%）中白种人的比例更高与 Q1（47.1%）相比（p<0.001）。与 Q5（258 分钟）相比，Q1（369 分钟）的发病至动脉穿刺时间更长（p=0.004）。在成功再通（TICI 2b-3）、出血性转化、出院时的中位数 NIHSS 评分、30 天再入院、家庭处置或住院时间等中风结局方面，Q1 和 Q5 之间没有显著差异。SES 不是良好功能结果（mRS 0-2）的显著预测因素。
本研究发现，接受急性缺血性中风机械血栓切除术的低 SES 和高 SES 患者的中风结局没有显著差异。SES 较高的患者从中风发作到动脉穿刺的持续时间较短，尽管没有统计学意义，但 SES 较高的患者 30 天再入院率和出院回家的比例较高。需要进一步研究证实。
