Patients in highest quintile of Social Vulnerability Index less likely to receive thrombolysis, mechanical thrombectomy
MONDAY, Oct. 21, 2024 (HealthDay News) — For patients with acute ischemic stroke, social determinants of health (SDOH) are associated with the likelihood of receiving thrombolysis or mechanical thrombectomy, according to a study published online Oct. 16 in Neurology.
Chathurika S. Dhanasekara, M.D., Ph.D., from Texas Tech University Health Sciences Center in Lubbock, and colleagues conducted a retrospective cohort analysis using Texas Emergency Department Public Use Data (2016 to 2019), including adults diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (the Social Vulnerability Index [SVI]) were computed.
Data were included for 139,852 patients with ischemic stroke; 12.3 and 4.3 percent received thrombolytic therapy and mechanical thrombectomy, respectively. The researchers found that the likelihood of thrombolysis was lower for those aged older than 65 versus 18 to 45 years (RR, 0.578); Black versus White individuals (RR, 0.801); Hispanic versus non-Hispanic individuals (RR, 0.936); Medicare/Medicaid/Veterans Affairs or uninsured versus private insurance holders (RR, 0.917 and 0.883, respectively); and those in a rural versus urban dwelling (RR, 0.782). Patients in the highest versus lowest quintile of the SVI were less likely to receive thrombolysis (RR, 0.926). The likelihood of receiving thrombectomy was lower for patients aged 65 years or older (RR, 0.787), Black or Hispanic patients (RRs, 0.745 and 0.919), those with Medicare/Medicaid/Veterans Affairs insurance (RR, 0.909), and those from a rural area (RR, 0.909). The SVI was also associated with a lower likelihood of undergoing mechanical thrombectomy (RR, 0.842).
“Our study provides evidence of socioeconomic disparities in access to thrombolysis or thrombectomy for acute ischemic stroke,” the authors write.
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