title: Racial and ethnic disparities in the treatment of unruptured intracranial aneurysms: a study of the Nationwide Inpatient Sample 2001-2009.
abstract: OBJECTIVE
  Minorities in the United States have less access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and sex disparities existed in the treatment of unruptured intracranial aneurysms.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, hospitalizations for clipping and coiling of intracranial aneurysms from 2001 to 2009 were identified by cross-matching International Classification of Diseases, 9th Revision codes for diagnosis of unruptured aneurysm and subarachnoid hemorrhage (SAH) with procedure codes for clipping or coiling of cerebral aneurysms. Demographic information analyzed included age (<50, 50-64, 65-79, and ≥80 years), race (white, black, Hispanic, Asian/Pacific Islander), sex, income quartile, primary payer (Medicare, Medicaid, private insurance, self-pay, no charge, other), and Charlson comorbidity index.
  
  
  RESULTS
  When compared with patients treated for SAH, those treated for unruptured intracranial aneurysm were significantly more likely to be women (75.0% versus 69.0%; P<0.0001). In all, 9.7% of patients receiving treatment for SAH were self-payers versus 3.0% of patients being treated for unruptured intracranial aneurysm (P<0.0001). In all, 62.2% of patients receiving treatment for SAH were white compared with 76.4% of patients being treated for unruptured intracranial aneurysm (P<0.0001). There was a higher proportion of black, Hispanic, and Asian patients in the SAH treatment group when compared with the unruptured aneurysm treatment group (P<0.0001 for all groups).
  
  
  CONCLUSIONS
  When compared with patients undergoing treatment for SAH, patients undergoing surgical and endovascular treatment for unruptured intracranial aneurysm are generally from higher socioeconomic strata and are more likely to be insured, women, and white. Future studies are needed to determine the underlying causes and solutions for this disparity.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 SW First St, Rochester, MN 55905, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D002532:Intracranial Aneurysm / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data