Racial Disparity in Outcome Measures After Endovascular Treatment for Stroke: A Systematic Review with Meta-analysis
Fabian Chavez-Ecos1, Aaron Rodriguez-Calienes2, Leonardo Uribe-Cavero3, Hashin Prada-Gutierrez3, Ximena Espiritu-Vilcapoma4, Carlos Alva-Diaz1
1Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú, 2University of Iowa Hospitals and Clinics, 3Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Universidad Nacional San Luis Gonzaga, Ica, Perú, 4Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru
Objective:
We aimed to assess the impact of racial background on outcomes following mechanical thrombectomy (MT).
Background:
MT is the gold standard treatment for acute ischemic stroke. However, emerging data suggest that racial and ethnic disparities in outcomes may persist despite advances in care.
Design/Methods:
We performed a comprehensive search across five databases up to September 2024, adhering to PRISMA-Equity and PROGRESS-plus guidelines. We included studies comparing outcomes between African American (AA) and White patients undergoing MT. The primary outcomes were functional independence, defined as a modified Rankin Scale score of 0-2 at 90 days, and mortality rates at 30 and 90 days.
Results:
We identified 14 studies comprising a total of 121,451 patients (median age 65 years; 53% female), including 22,696 AA patients and 98,755 White patients. The odds of achieving functional independence were comparable between AA and White patients (AA: 27.1% vs. White: 28.1%; OR = 0.91, 95% CI: 0.80–1.03), with moderate heterogeneity (I² = 32%). At 90 days, mortality odds were 24% lower in AA patients compared to White patients (AA: 24.6% vs. White: 33%; OR = 0.76, 95% CI: 0.66–0.89), with no heterogeneity observed (I² = 0%). Similarly, 30-day mortality odds were 26% lower in AA patients compared to White patients (AA: 9.6% vs. White: 15.4%; OR = 0.74, 95% CI: 0.64–0.86), though significant heterogeneity was present (I² = 83%).
Conclusions:
Despite achieving similar odds of functional independence, AA patients demonstrated significantly lower mortality rates at both 30 and 90 days compared to White patients following MT. These findings highlight the need for further exploration of factors driving these disparities, which may inform more equitable stroke care.
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