Striving for Socioeconomic Equity in Ischemic Stroke Care: Imaging and Acute Treatment Utilization From a Comprehensive Stroke Center.
Striving for Socioeconomic Equity in Ischemic Stroke Care: Imaging and Acute Treatment Utilization From a Comprehensive Stroke Center.
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DOI：
10.1016/j.jacr.2021.07.027
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Sanelli PC
中科院分区：
文献类型：
--
作者：
Wang JJ;Boltyenkov A;Katz JM;O'Hara J;Gribko M;Sanelli PC
先前的研究表明，缺血性卒中患者在高级神经影像学和急性治疗利用方面存在社会经济差异。我们分析了社会经济因素是否与综合性卒中中心的卒中神经影像学和急性治疗利用相关。对2012-2020年综合性卒中中心的连续急性缺血性卒中出院情况进行了回顾性研究。根据年龄、性别、种族、保险类型和社区水平的家庭收入中位数等社会经济因素，评价了神经影像学（CTA、CTP、MRI、MRA）和急性治疗（静脉溶栓- IVT、血管内血栓切除术- EVT）利用率的差异。双变量分析采用卡方检验。进行多变量logistic回归分析，以确定社会经济因素与神经影像学或治疗利用之间的关联，同时控制卒中特异性因素和合并症。在6,140例缺血性卒中出院患者中，在控制卒中特异性因素和合并症后，种族和保险类型与神经影像学（CTA、CTP、MRI、MRA）或急性卒中治疗（IVT、EVT）的利用率较低无显著相关性。然而，家庭收入中位数<80，000美元/年与IVT使用率较低相关（OR=0.74 [0.63-0.87]）。此外，80岁以上的患者CTA（OR=0.62 [0.51-0.75]）和EVT（OR=0.53 [0.39-0.73]）较低，女性CTA利用率较低（OR=0.78 [0.65-0.93]）。在亚洲患者（OR=1.33 [1.04-1.69]）和无保险患者（OR=1.64 [1.07-2.50]）中，MRI的利用率显着较高，在有私人保险的患者中，MRA（OR=1.24 [1.04-1.49]）和EVT（OR=1.62 [1.20-2.20]）的利用率显着较高。一旦进入综合性卒中中心，缺血性卒中患者在医疗资源利用方面的社会经济差异，特别是先进的神经影像学和急性治疗，可能会得到改善。本研究的目的是评估2012年至2020年缺血性卒中患者中与社会经济因素（年龄、性别、种族、健康保险类型、家庭收入中位数）相关的高级神经影像学和急性治疗利用的差异。
Prior studies have shown socioeconomic disparities in advanced neuroimaging and acute treatment utilization in ischemic stroke patients. We analyzed whether socioeconomic factors were associated with stroke neuroimaging and acute treatment utilization at a comprehensive stroke center. Retrospective study of consecutive acute ischemic stroke discharges at a comprehensive stroke center was performed from 2012–2020. Differences in neuroimaging (CTA, CTP, MRI, MRA) and acute treatment (intravenous thrombolysis – IVT, endovascular thrombectomy – EVT) utilization were evaluated based on socioeconomic factors of age, sex, race, insurance type, and neighborhood-level median household income. Chi-square tests were used for bivariate analyses. Multivariable logistic regression analyses were performed to determine associations between socioeconomic factors and neuroimaging or treatment utilization, while controlling for stroke-specific factors and comorbidities. Of 6,140 ischemic stroke discharges, race and insurance type were not significantly associated with lower utilization of neuroimaging (CTA, CTP, MRI, MRA) or acute stroke treatment (IVT, EVT), after controlling for stroke-specific factors and comorbidities. However, median household income <$80,000/year was associated with lower IVT use (OR=0.74 [0.63–0.87]). In addition, age 80+ years had lower CTA (OR=0.62 [0.51–0.75]) and EVT (OR=0.53 [0.39–0.73]), and female sex had lower CTA (OR=0.78 [0.65–0.93]) utilization. Significantly higher utilization was observed for MRI in Asian (OR=1.33 [1.04–1.69]) and uninsured patients (OR=1.64 [1.07–2.50]), and MRA (OR=1.24 [1.04–1.49]) and EVT (OR=1.62 [1.20–2.20]) in privately-insured patients. Once access to a comprehensive stroke center is achieved, socioeconomic disparities in the utilization of healthcare resources, particularly advanced neuroimaging and acute treatment, may be improved in ischemic stroke patients. The purpose of this study was to assess for differences in advanced neuroimaging and acute treatment utilization associated with socioeconomic factors (age, sex, race, health insurance type, median household income) in ischemic stroke patients from 2012 to 2020.
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