학술논문
Trends in Disparities in Advanced Neuroimaging Utilization in Acute Stroke: A Population-Based Study.
Document Type
Academic Journal
Author
Vagal A; Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH.; Sucharew H; Department of Emergency Medicine (H.S.), University of Cincinnati Medical Center, OH.; Wang LL; Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH.; Kissela B; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Alwell K; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Haverbusch M; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Woo D; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Ferioli S; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Mackey J; Indiana University School of Medicine, Indianapolis (J.M.).; De Los Rios La Rosa F; Baptist Health Miami Neuroscience Institute, FL (F.R.).; Mistry EA; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Demel SL; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Coleman E; University of Chicago Medical Center, IL (E.C.).; Jasne AS; Yale-New Haven Hospital, CT (A.J.).; Walsh K; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Khatri P; Department of Neurology (B.K., K.A., M.H., D.W., S.F., E.M., S.D., K.W., P.K.), University of Cincinnati Medical Center, OH.; Slavin S; University of Kansas Medical Center (S.S.).; Star M; Soroka Medical Center, Beersheba, Israel (M.S.).; Stephens C; Department of Radiology (A.V., L.W., C.S.), University of Cincinnati Medical Center, OH.; Kleindorfer D; University of Michigan, Ann Arbor (D.K.).
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0235266 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4628 (Electronic) Linking ISSN: 00392499 NLM ISO Abbreviation: Stroke Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Our primary objective was to evaluate if disparities in race, sex, age, and socioeconomic status (SES) exist in utilization of advanced neuroimaging in year 2015 in a population-based study. Our secondary objective was to identify the disparity trends and overall imaging utilization as compared with years 2005 and 2010.
Methods: This was a retrospective, population-based study that utilized the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) data. Patients with stroke and transient ischemic attack were identified in the years 2005, 2010, and 2015 in a metropolitan population of 1.3 million. The proportion of imaging use within 2 days of stroke/transient ischemic attack onset or hospital admission date was computed. SES determined by the percentage below the poverty level within a given respondent's US census tract of residence was dichotomized. Multivariable logistic regression was used to determine the odds of advanced neuroimaging use (computed tomography angiogram/magnetic resonance imaging/magnetic resonance angiogram) for age, race, gender, and SES.
Results: There was a total of 10 526 stroke/transient ischemic attack events in the combined study year periods of 2005, 2010, and 2015. The utilization of advanced imaging progressively increased (48% in 2005, 63% in 2010, and 75% in 2015 [ P <0.001]). In the combined study year multivariable model, advanced imaging was associated with age and SES. Younger patients (≤55 years) were more likely to have advanced imaging compared with older patients (adjusted odds ratio, 1.85 [95% CI, 1.62-2.12]; P <0.01), and low SES patients were less likely to have advanced imaging compared with high SES (adjusted odds ratio, 0.83 [95% CI, 0.75-0.93]; P <0.01). A significant interaction was found between age and race. Stratified by age, the adjusted odds of advanced imaging were higher for Black patients compared with White patients among older patients (>55 years; adjusted odds ratio, 1.34 [95% CI, 1.15-1.57]; P <0.01), but no racial differences among the young.
Conclusions: Racial, age, and SES-related disparities exist in the utilization of advanced neuroimaging for patients with acute stroke. There was no evidence of a change in trend of these disparities between the study periods.
Methods: This was a retrospective, population-based study that utilized the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) data. Patients with stroke and transient ischemic attack were identified in the years 2005, 2010, and 2015 in a metropolitan population of 1.3 million. The proportion of imaging use within 2 days of stroke/transient ischemic attack onset or hospital admission date was computed. SES determined by the percentage below the poverty level within a given respondent's US census tract of residence was dichotomized. Multivariable logistic regression was used to determine the odds of advanced neuroimaging use (computed tomography angiogram/magnetic resonance imaging/magnetic resonance angiogram) for age, race, gender, and SES.
Results: There was a total of 10 526 stroke/transient ischemic attack events in the combined study year periods of 2005, 2010, and 2015. The utilization of advanced imaging progressively increased (48% in 2005, 63% in 2010, and 75% in 2015 [ P <0.001]). In the combined study year multivariable model, advanced imaging was associated with age and SES. Younger patients (≤55 years) were more likely to have advanced imaging compared with older patients (adjusted odds ratio, 1.85 [95% CI, 1.62-2.12]; P <0.01), and low SES patients were less likely to have advanced imaging compared with high SES (adjusted odds ratio, 0.83 [95% CI, 0.75-0.93]; P <0.01). A significant interaction was found between age and race. Stratified by age, the adjusted odds of advanced imaging were higher for Black patients compared with White patients among older patients (>55 years; adjusted odds ratio, 1.34 [95% CI, 1.15-1.57]; P <0.01), but no racial differences among the young.
Conclusions: Racial, age, and SES-related disparities exist in the utilization of advanced neuroimaging for patients with acute stroke. There was no evidence of a change in trend of these disparities between the study periods.