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

Friday, May 3, 2024

Presenting Author(s)

Zahraa F. Al-Sharshahi, MD (she/her/hers)

Resident
Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Ky, USA
Lexington, KY, US

Co-Author(s)

ZA

Zaid Aljuboori, MD

Assistant professor
Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Danville, PA, USA, United States
David Dornbos, III, MD (he/him/his)

Assistant Professor of Neurosurgery
University of Kentucky College of Medicine
Lexington, Kentucky, United States
JF

Jacqueline Frank, BS

Data Research Analyst
University of Kentucky College of Medicine, United States
RN

Rachel Norris, MS

Clinical Research Associate
Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Ky, USA, United States
Anthony Parisi, MD

Resident
Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, Ky, USA
Lexington, Kentucky, United States
MS

Mohamed Lemine Sidi, n/a

Medical student
College of Medicine, University of Sharjah, Sharjah, UAE, United States
Jeremiah H. Wijaya, MD (he/him/his)

Research Fellow
Faculty of Neurosurgery, Department of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
Tangerang, ID

Introduction: This meta-analysis is set to assess the impact of socioeconomic status (SES) on clinical outcomes following mechanical thrombectomy (MT).

Methods: This is a PRISMA-compliant study. Variable combinations of keywords and MESH terms were used to query PubMed, MEDLINE Plus, COCHRANE, EMBASE, and CINAHL databases for human studies published through October 2023.

Studies were included if they (1) reported MT outcomes, (2) examined SES as an independent outcome predictor, and (3) included a follow-up period exceeding 90 days.

Random-effects meta-analysis was conducted, with the modified Rankin Scale (mRS) at 90 days as the outcome measure. Outcomes were dichotomized into favorable and unfavorable. Statistical analyses were conducted using R Studio with the Metafor package. Significance was set at a P-value of 0.05, and heterogeneity was assessed using I2 and Cochrane Q scores. Funnel plot analysis was employed to assess and address potential publication bias.

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. 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 were the primary outcome measure. The studies were of reasonably good quality with a combined NOS score of 30 (Figure 2).
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) (figure 3). 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 (figure 4).

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.