Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes.
Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes.
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105488
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Sanjana Salwi;K. Kelly;Pious D. Patel;M. Fusco;E. Mistry;A. Mistry;R. Chitale
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文献类型：
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作者：
Sanjana Salwi;K. Kelly;Pious D. Patel;M. Fusco;E. Mistry;A. Mistry;R. Chitale
背景/目的本研究旨在评估社区社会经济状况对急性缺血性卒中（AIS）机械取栓（MT）结果的影响。方法：我们对2012 - 2018年在美国某脑卒中综合中心连续接受MT治疗的成年AIS患者进行了一项前瞻性观察研究。综合社区社会经济评分（nSES）使用患者家庭住址、家庭收入中位数、有利息、股息或租金收入的家庭百分比、住房单位的中位数价值、25岁或以上具有高中学历、大学学历或从事行政、管理或专业专业职业的人的百分比创建。使用该评分将患者分为低、中、高三组。结果包括90天功能独立性、院内死亡率、住院时间、出院地点、再通时间、再通成功和症状性颅内出血（siich）。结果共纳入328例患者。三组间白人患者比例、再通时间、入院NIH脑卒中量表差异均有统计学意义（p<0.05）。高nSES评分的患者在90天时更有可能出现功能依赖（未经调整的OR， 95% CI, 1.91[1.10, 3.36]），在医院死亡的可能性更小（未经调整的OR， 95% CI, 0.46,[0.20, 0.98]）。此外，高nSES组患者的再通次数减少（中位时间（分钟），低=335，中=368，高=297,p=0.04）。然而，在调整了种族和中风严重程度的差异后，临床结果的差异并不显著。结论：本研究强调了未调整的社区社会经济地位如何与AIS MT后的功能结局、死亡率和再通时间显著相关。由于调整修正了显著关联，社会经济差异可能受到院前因素差异的影响，这些因素驱动中风严重程度和再通时间。更好地了解这些因素的相互作用可能会导致更及时的评估和改善患者的结果。
Background/PurposeOur study aimed to assess the impacts of neighborhood socioeconomic status on mechanical thrombectomy (MT) outcomes for acute ischemic stroke (AIS).MethodsWe conducted a prospective observational study of consecutive adult AIS patients treated with MT at one US comprehensive stroke center from 2012 to 2018. A composite neighborhood socioeconomic score (nSES) was created using patient home address, median household income, percentage of households with interest, dividend, or rental income, median value of housing units, percentage of persons 25 or older with high school degrees, college degrees or holding executive, managerial or professional specialty occupations. Using this score, patients were divided into low, middle and high nSES tertiles. Outcomes included 90-day functional independence, in-hospital mortality, length of hospital stay, discharge location, time to recanalization, successful recanalization, and symptomatic intracranial hemorrhage (sICH).Results328 patients were included. Between the three nSES groups, proportion of White patients, time-to-recanalization and admission NIH stroke scale differed significantly (p<0.05). Patients in the high nSES tertile were more likely to be functionally dependent at 90 days (unadjusted OR, 95% CI, 1.91 [1.10, 3.36]) and were less likely to die in the hospital (unadjusted OR, 95% CI, 0.46, [0.20, 0.98]). Further, patients in the high nSES tertile had decreased times to recanalization (median time in minutes, low=335, mid=368, high=297, p=0.04). However, after adjusting for variance in race and severity of stroke, the differences in clinical outcomes were not significant.ConclusionThis study highlights how unadjusted neighborhood socioeconomic status is significantly associated with functional outcome, mortality, and time-to-recanalization following MT for AIS. Since adjustment modifies the significant association, the socioeconomic differences may be influenced by differences in pre-hospital factors that drive severity of stroke and time to recanalization. Better understanding of the interplay of these factors may lead to timelier evaluation and improvement in patient outcomes.