Not much has changed much in the last decade—the findings mirror disparities seen as far back as 2000, researchers say.
Nonwhite individuals and those with lower socioeconomic status are last apt to undergo repair of unruptured intracranial aneurysms (UIAs) and more likely to be treated for subarachnoid hemorrhage (SAH), according to a study of hospital admissions from 2014 to 2018.
These findings mirror disparities seen in previous research dating back to 2000, the resarchers say.
“Unfortunately, this suggests that no progress has been made in reducing the gap in access to treatment of UIAs among minorities and those with limited or no insurance over the past decade,” write Lorenzo Rinaldo, MD (Mayo Clinic, Rochester, MN), and colleagues in a paper published online January 23, 2019, ahead of print in the Journal of NeuroInterventional Surgery.
Commenting on the study, Kimon Bekelis, MD (Dartmouth-Hitchcock Medical Center, Lebanon, NH), told Neurovascular Exchange that “socioeconomic disparities are very prevalent in medicine. Especially for life-threatening disorders such as brain aneurysms, identifying disparities and addressing them can lead to improved outcomes.”
Rinaldo et al used a national database to identify 10,545 admissions for clipping or coiling of an UIA and 33,166 admissions for aneurysmal SAH and compared them according to age, sex, race/ethnicity, and insurance status.
The population admitted for management of an UIA included a higher proportion of women than did the SAH cohort (72.2% vs 60.8%; P < 0.001). A greater proportion of patients were white/non-Hispanic in the UIA group (64.3%) compared with in the SAH group (48.2%; P < 0.001). Conversely, black/Hispanic patients presented more frequently with SAH (29.3%) than with UIA (26.1%; P = 0.006).
In multivariate analysis female sex was positively correlated with admission for an UIA, while having Medicaid or no insurance was negatively correlated with admission for an UIA, as was black/Hispanic race/ethnicity.
Independent Predictors of Treatment of UIA
|
|
Beta Coefficient |
T Value |
|
Female Sex |
0.93 |
< 0.001 |
|
Age ≥ 65 years |
-0.21 |
0.223 |
|
Medicaid/Uninsured |
-0.29 |
0.003 |
|
White/Non-Hispanic |
-0.06 |
0.076 |
|
Black/Hispanic |
-0.17 |
0.010 |
Bekelis said it remains unclear precisely why these disparities persist. “Factors such as availability of health services for some socioeconomic groups or cultural stereotypes and willingness to undergo treatment should be considered,” he said. “Higher rupture rates in these socioeconomic groups can [also] be considered as a potential confounding factor.”
In light of these and similar findings, Bekelis recommends more public health measures to raise awareness of the potentially deadly implications of brain aneurysms.
Source:
Rinaldo L, Rabinstein AA, Cloft HJ, et al. Racial and economic disparities in the access to treatment of unruptured intracranial aneurysms are persistent problems. J NeuroInterv Surg. 2018;Epub ahead of print.
Disclosures:
Rinaldo and Bekelis report no relevant conflicts of interest.
