Socioeconomic Status and Mechanical Thrombectomy Outcomes: A Systematic Review and Meta-Analysis

Introduction: We aimed to assess the impact of socioeconomic status (SES) on clinical outcomes following mechanical thrombectomy (MT).

Methods: In accordance with PRISMA guidelines, a comprehensive search strategy was employed, utilizing a range of keywords and MeSH terms related to SES, MT, and stroke outcomes (Figure 1). Four databases (PubMed, Embase, CINAHL, and the Cochrane Library) were systematically searched from their inception to the present. Eligible studies were required to meet all three criteria: (1) report MT outcomes, (2) examine SES as an independent outcome predictor, and (3) include a follow-up period exceeding 90 days. No study design or publication date-related constraints were applied. Screening and data extraction were conducted independently by two reviewers using Rayyan software, with a focus on patient characteristics, SES factors, study design, statistical methods, and MT outcomes.

Results: Out of 39 initially identified articles, four met inclusion criteria after screening. Three studies were from the US, and one was from Denmark. Socioeconomic status definitions varied, including factors such as age, sex, education, income, and insurance status. Sample sizes ranged from 328 to 1,322,162 patients. Three studies used registries (2 retrospective, and 1 prospective), and one was a cohort observational study. Functional outcomes, assessed by the modified Rankin Scale (mRS) at 90 days was the primary outcome measure. The studies were of reasonably good quality with a combined NOS score of 30. Meta-analysis results showed a significant association between socioeconomic status and functional outcomes, with an odds ratio (OR) of 1.4 (95% CI: 1.16-1.7, p = 0.001). The Z-score was 3.46, indicating statistical significance. However, substantial heterogeneity was observed (I² = 99.96%, p = 0.0005), confirmed by Cochrane's Q statistic (Q = 1257.12, p < 0.0001). Funnel plot asymmetry suggests potential publication bias.

Conclusion : Lower SES is associated with poorer functional outcomes following MT. However, the presence of substantial heterogeneity and potential publication bias should be considered in the interpretation of these findings.