Racial and socioeconomic disparities in the utilization of mechanical thrombectomy: a meta-analysis and systematic review of over 11 million patients.

Abstract

Objective: Understanding racial and socioeconomic disparities in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is crucial to addressing these critical healthcare challenges. The authors aimed to evaluate racial and socioeconomic disparities in MT usage for patients with AIS.

Methods: The authors performed a comprehensive search of four electronic databases for studies assessing racial and socioeconomic disparity in MT utilization among Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Native American, and Other race groups. Outcomes were measured by calculating proportions and 95% CIs for each study using a random-effects model due to expected clinical and methodological heterogeneity.

Results: A total of 11,583,329 patients from 11 studies were included in this systematic review and meta-analysis. The racial breakdown involved 1,864,453 Asian, 2,260,026 NHB, 2,070,186 Hispanic, 5,239,707 NHW, 23,724 Native American, and 125,233 Other patients. Although MT utilization was highest in NHW (2.55%, 95% CI 1.0%-4.8%) and lowest in Native American (0.87%, 95% CI 0.0%-6.8%) patients, the subgroup analysis showed no statistically significantly difference (p = 0.71). Additionally, there was no significant difference in intravenous tissue-type plasminogen activator (IV-tPA) usage rate (p = 0.14) among the races. The MT utilization rate was significantly different in patients who were in the first (p < 0.00001), second (p < 0.0001), third (p < 0.0001), and fourth (p < 0.00001) income quartiles. Among insurance types, disparity in thrombectomy usage was not significantly different in patients with Medicaid (p = 0.99) and Medicare (p = 0.99), while it was significant in patients with private (p < 0.0001) or self-pay (p < 0.0001) insurance.

Conclusions: Although our findings showed no disparity in thrombectomy and IV-tPA utilization, there is still a significant disparity in accessibility to thrombectomy based on insurance types and income quartiles. This study offers future directions for healthcare providers and state legislators to address racial and socioeconomic disparities.