title: Health disparities in time to aneurysm clipping/coiling among aneurysmal subarachnoid hemorrhage patients: a national study.
abstract: OBJECTIVE
  Previous studies have suggested disparities in quality of health care and time to treatment across socioeconomic groups. Such differences can be of greatest consequence in the setting of emergent medical conditions. Surgical or endovascular treatment of ruptured cerebral aneurysms within the first 3 days of aneurysmal subarachnoid hemorrhage (aSAH) is associated with improved outcome. We hypothesize that race and payer status disparities effect the time to treatment for ruptured aneurysms.
  
  
  METHODS
  Discharge data were collected from the Nationwide Inpatient Sample during the years 2002-2010. International Classification of Diseases, 9th Edition; Clinical Modification codes were used to identify patients with aSAH who were treated by either surgical clipping or endovascular coil embolization. Time to procedure was dichotomized into 1) treatment in 3 days or less or 2) treatment in greater than 3 days. Time to treatment was evaluated according to demographic factors, including race, payer status, and median zip code income via multivariable analysis.
  
  
  RESULTS
  A total of 78,070 aSAH admissions were treated by either aneurysm clip ligation or coil embolization. Hispanic race and Medicaid payer status were associated with increased time to treatment (P < 0.05).
  
  
  CONCLUSIONS
  Racial and socioeconomic factors are associated with delayed time to treatment in aSAH. Identification of factors underlying these delays and standardization of care may allow for more uniform treatment protocols and improved patient care.
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Attenello
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Electronic address: kelseywa@usc.edu.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Wang
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wen
authors.affiliation: Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Cen
authors.affiliation: Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: May
authors.initials: M
authors.lastname: Kim-Tenser
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Arun P
authors.initials: AP
authors.lastname: Amar
authors.affiliation: Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Giannotta
authors.affiliation: Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Aneurysm clipping; Aneurysm coiling; Hospital performance; Ruptured aneurysm; Subarachnoid hemorrhage; Surgery