Racial, Gender, and Socioeconomic Disparities in Mechanical Thrombectomy Utilization Among Stroke Patients: A Nationwide Analysis from the NIS (2018-2020)
Marium Mirza1, Maheen Kalwar2, Rawdah Shakil3, Zain Nadeem4, Syed Sarmad Javaid5, Hafiz Maaz6, Muhammad Tayyab Muzaffar Chaychi7, Maria Saleem8, Muhammad Sohaib9, Syeda Alisha Johar10, FNU Javairia4, Isha Munir11, Sophia Ahmed4, Eiman Zeeshan12, Syeda Aamna Waqar13
1Ziauddin Medical University,Karachi,Pakistan, 2Dr. Ruth K. M. Pfau Civil Hospital Karachi, 3Dow International Medical College,Karachi, Pakistan, 4Allama Iqbal Medical College,Lahore,Pakistan, 5Department of Medicine, University of Mississipi Medical Center, USA, 6Quaid-e-Azam Medical College, Bahawalpur Pakistan, 7Department of Neurology, University of South Florida, 8Karachi Medical and dental college, Karachi, Pakistan, 9Rollins school of Public Health, Emory University, Atlanta, 10Dow Medical College, Karachi, Pakistan, 11Liaquat College of Medicine And Dentistry, 12Dow Dental College, Karachi, Pakistan, 13Rehman Medical College, Pakistan
Objective:
To examine the impact of age, sex, race, geographic location, and income on the utilization of mechanical thrombectomy in stroke patients in the United States, using data from the National Inpatient Sample (NIS) from 2018 to 2020.
Background:
Mechanical thrombectomy is recognized as a critical intervention for patients with acute ischemic stroke, significantly improving outcomes while decreasing morbidity and mortality. However, disparities in healthcare access may limit its equitable use, a concern not previously studied.
Design/Methods:
Stoke patients who underwent mechanical thrombectomy between 2018-2020 were identified from the National Inpatient Sample (NIS) database using ICD-10 codes I63 (stroke), 03CG3ZZ (Thrombectomy), and Z9282/3E03317 (IV-tPA). Medians and interquartile ranges (IQRs) were calculated for descriptive statistics, and odds ratios (ORs) were used for associations. A p<0.05 was considered statistically significant.
Results:
A total of 1,560,970 (97.45%) patients out of 1,601,840 hospital admissions principally diagnosed with stroke, with a median age of 71 (IQR 61–81) years, were included in the study. Males were significantly less likely to undergo thrombectomy than females (OR 0.89, p<0.001). Native Americans (OR 0.64, p=0.031), Blacks (OR 0.78, p<0.001), and Hispanics (OR 0.81, p<0.001) were less likely to undergo mechanical thrombectomy than Whites. However, patients in the East South Central (OR 1.32, p=0.006), Mountain (OR 1.25, p=0.021), Pacific (OR 1.18, p=0.037), and South Atlantic (OR 1.25, p=0.002) regions exhibited higher thrombectomy utilization than those in the East North Central. Patients with the highest residential income (>$88,000) also demonstrated a higher likelihood of receiving thrombectomy (OR 1.15, p=0.001) compared to those with lower incomes (<$52,000).
Conclusions:
The disparities in mechanical thrombectomy utilization particularly affect minority groups, males, lower-income individuals, and those treated at non-metropolitan or rural hospitals. These findings emphasize the importance of collecting socio-demographic information for all hospital admissions to improve outcomes for patients undergoing thrombectomy for ischemic strokes.
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