title: Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke.
abstract: BACKGROUND
  Previous studies have demonstrated that socioeconomic disparities in access to treatment of cerebrovascular diseases exist. We studied the Nationwide Inpatient Sample (NIS) to determine if disparities exist in utilization of mechanical thrombectomy for acute ischemic stroke.
  
  
  METHODS
  Using the NIS for the years 2006-2010, we selected all discharges with a primary diagnosis of acute ischemic stroke. Patients who received mechanical thrombectomy for stroke were identified by using the International Classification of Diseases, Ninth Revision, procedure code 39.74. We examined the utilization rates of mechanical thrombectomy by race/ethnicity (white, black, Hispanic, and Asian/Pacific Islander), income quartile (first, second to third, and fourth), and insurance status (Medicare, Medicaid, self-pay, and private). We also studied thrombectomy utilization rates at hospitals that performed thrombectomy.
  
  
  RESULTS
  From 2006 to 2010, 2,087,017 patients were hospitalized with a primary diagnosis of acute ischemic stroke; 8946 patients (.4%) received mechanical thrombectomy. Compared with white patients, black patients had significantly lower rates of overall mechanical thrombectomy utilization (odds ratio [OR] = .59, 95% confidence interval [CI] = .55-.64, P < .0001) and at centers that offered mechanical thrombectomy (OR = .44, 95% CI = .41-.47, P < .0001). Compared with patients in the highest income quartile, patients in the lowest income quartile had significantly lower rates of mechanical thrombectomy utilization both overall (OR = .66, 95% CI = .62-.70, P < .0001) and at centers that offered mechanical thrombectomy (OR = .80, 95% CI = .75-.84, P < .0001). Compared with patients with private insurance, self-pay patients had significantly lower mechanical thrombectomy utilization both overall (OR = .71, 95% CI = .64-.78, P < .0001) and at centers that offered mechanical thrombectomy (OR = .81, 95% CI = .74-.90, P < .0001).
  
  
  CONCLUSIONS
  Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota. Electronic address: brinjikji.waleed@mayo.edu.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics* / Q000208:ethnology / Q000628:therapy*; D016009:Chi-Square Distribution; D005006:Ethnicity; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000208:ethnology / Q000628:therapy*; D017131:Thrombectomy / Q000191:economics* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Mechanical thrombectomy; acute ischemic stroke; epidemiology; socioeconomics