title: Racial and socioeconomic disparities in access to mechanical revascularization procedures for acute ischemic stroke.
abstract: BACKGROUND
  Mechanical revascularization procedures performed for treatment of acute ischemic stroke have increased in recent years. Data suggest association between operative volume and mortality rates. Understanding procedural allocation and patient access patterns is critical. Few studies have examined these demographics.
  
  
  METHODS
  Data were collected from the 2008 Nationwide Inpatient Sample database. Patients hospitalized with ischemic stroke and the subset of individuals who underwent mechanical thrombectomy were characterized by race, payer source, population density, and median wealth of the patient's zip code. Demographic data among patients undergoing mechanical thrombectomy procedures were examined. Stroke admission demographics were analyzed according to thrombectomy volume at admitting centers and patient demographics assessed according to the thrombectomy volume at treating centers.
  
  
  RESULTS
  Significant allocation differences with respect to frequency of mechanical thrombectomy procedures among stroke patients existed according to race, expected payer, population density, and wealth of the patient's zip code (P < .0001). White, Hispanic, and Asian/Pacific Islander patients received endovascular treatment at higher rates than black and Native American patients. Compared with the white stroke patients, black (P < .001), Hispanic (P < .001), Asian/Pacific Islander (P < .001), and Native American stroke patients (P < .001) all demonstrated decreased frequency of admission to hospitals performing mechanical thrombectomy procedures at high volumes. Among treated patients, blacks (P = .0876), Hispanics (P = .0335), and Asian/Pacific Islanders (P < .001) demonstrated decreased frequency in mechanical thrombectomy procedures performed at high-volume centers when compared with whites. While present, socioeconomic disparities were not as consistent or pronounced as racial differences.
  
  
  CONCLUSIONS
  We demonstrate variances in endovascular acute stroke treatment allocation according to racial and socioeconomic factors in 2008. Efforts should be made to monitor and address potential disparities in treatment utilization.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: attenell@usc.edu.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Attenello
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Peter
authors.initials: P
authors.lastname: Adamczyk
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Ge
authors.initials: G
authors.lastname: Wen
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Shuhan
authors.initials: S
authors.lastname: He
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Katie
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Russin
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Arun P
authors.initials: AP
authors.lastname: Amar
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D015276:Health Care Rationing; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000208:ethnology*; D061847:Hospitals, High-Volume; D006801:Humans; D010343:Patient Admission; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Racial disparities; acute stroke; mortality; neurointerventional procedures; socioeconomic disparities; thrombectomy