Abstract TP390: Ethnic and Regional Disparities in Access to Endovascular Embolectomy for Acute Ischemic Stroke
Background: Endovascular stroke treatment volume has significantly increased in recent years. Data from the Nationwide Inpatient Sample (NIS) database in 2008 demonstrates an association between improved outcomes and centers that perform substantial procedural volume (>10/year). Few reports have described demographics of patient populations or centers performing mechanical thrombectomy.
Methods: We collected data from the 2008 NIS database for patients hospitalized for ischemic stroke, and those undergoing mechanical clot retrieval. Patients were characterized by ethnicity, payment source, and regional hospital variables of population density and median zipcode wealth. Patients were evaluated for admission and treatment at substantial thrombectomy volume centers.
Results: Approximately 1.1 million patients were hospitalized for acute stroke, with 2749 patients receiving mechanical thrombectomy in 2008. Asian patients received the highest frequency of intervention (0.39%) with Blacks and Native Americans receiving the lowest (0.18%, 0.17%). Patients from zipcodes with highest median wealth most frequently received intervention (0.29%, p<0.001). Among all stroke patients, Whites, Hispanics, individuals in highest salaried zip codes and patients residing in counties with population > 1 million were most often admitted to centers with substantial endovascular procedural volume (all, p<0.001 in multivariate analysis). Among those undergoing thrombectomy, Hispanics (p=0.03, OR 0.654 [0.442,0.967]), Asians (p=<0.001, 0.205 [0.120,0.350]) and Blacks (p=0.09, OR 0.717[0.489,1.050]), were treated less frequently than Whites at substantial volume centers.
Conclusion: Native Americans and Blacks received the lowest frequency of thrombectomy for acute ischemic stroke. Whites, individuals residing in wealthy and high population density regions were more often admitted to centers performing substantial procedural volume. Among patients undergoing mechanical thrombectomy, Whites were more often treated at substantial volume centers than Hispanics, Blacks or Asians. Though noted correlations may be multi-factorial, socioeconomic factors may predict admission and treatment in high volume procedural centers.
- © 2012 by American Heart Association, Inc.