Socioeconomic Disparities in Mechanical Thrombectomy Access for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Introduction: The Study investigates the impact of socioeconomic status (SES) on access to mechanical thrombectomy (MT).

Methods: A comprehensive literature search was conducted, spanning from the inception of the databases (PubMed, Cochrane Library, and CINAHL) to September 14, 2023, with a focus on the following keywords and their synonyms: mechanical thrombectomy, acute ischemic stroke, utilization, access, socioeconomic. Parameters included insurance type, race, and sex. Insurance types were categorized into Medicare, Medicaid, private insurance, self-payment, and other payment methods. Similarly, race was stratified into African American, Caucasian, Asian or Pacific Islander, Native American, Hispanic, and other racial categories. To facilitate comparisons within insurance groups, the private insurance category served as the reference group, whereas for race-based comparisons, Caucasian was the reference point. The effect measurement was presented in the form of a relative risk (RR). Der-Simonian Laird random-effects meta-analysis model was used.

Results: A total of eight studies involving a substantial sample size (n = 6,222,928) were incorporated. The included studies demonstrated a Newcastle-Ottawa Scale (NOS) score in the range of 6 to 7. The meta-analysis revealed several key findings. African American individuals were found to have a slightly reduced likelihood of accessing MT when compared to their Caucasian counterparts (RR 0.89 [0.52; 1.521]; p = 0.01). Furthermore, the analysis indicated that males are more likely to undergo this treatment than females (RR 1.18 [1.06; 1.32]; p < 0.01). Individuals covered by Medicare were found to exhibit a decreased likelihood of accessing MT for the management of acute ischemic stroke in comparison to those with private insurance (RR 0.39 [0.16; 0.94]; p = 0.01).

Conclusion : Substantial socioeconomic inequalities are evident in access to MT.