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Health inequities and socioeconomic factors predicting the access to treatment for unruptured intracranial aneurysms in the USA in the last 20 years: interaction effect of race, gender, and insurance
  1. Sandeep Kandregula1,
  2. Amey Savardekar1,
  3. Robbie Beyl2,
  4. Joshua Caskey1,
  5. Danielle Terrell1,
  6. Nimer Adeeb1,
  7. Stephen Garrett Whipple1,
  8. William Christopher Newman3,
  9. Jamie Toms1,
  10. Jennifer Kosty1,
  11. Pankaj Sharma4,
  12. Edward J Mayeaux Jr5,
  13. Hugo Cuellar6,
  14. Bharat Guthikonda1
  1. 1 Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, USA
  2. 2 Biostatistics, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  3. 3 Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4 Neurology, LSU Health Shreveport, Shreveport, Louisiana, USA
  5. 5 Family Medicine, LSU Health Shreveport, Shreveport, Louisiana, USA
  6. 6 Radiology, LSU Health Shreveport, Shreveport, Louisiana, USA
  1. Correspondence to Dr Bharat Guthikonda, LSU Health Shreveport, Shreveport, Louisiana, USA; bharat.guthikonda{at}


Background The literature suggests that minority racial and ethnic groups have lower treatment rates for unruptured intracranial aneurysms (UIA). It is uncertain how these disparities have changed over time.

Methods A cross-sectional study using the National Inpatient Sample database covering 97% of the USA population was carried out.

Results A total of 213 350 treated patients with UIA were included in the final analysis and compared with 173 375 treated patients with aneurysmal subarachnoid hemorrhage (aSAH) over the years 2000–2019. The mean (SD) age of the UIA and aSAH groups was 56.8 (12.6) years and 54.3 (14.1) years, respectively. In the UIA group, 60.7% were white patients, 10.2% were black patients, 8.6% were Hispanic, 2% were Asian or Pacific Islander, 0.5% were Native Americans, and 2.8% were others. The aSAH group comprised 48.5% white patients, 13.6% black patients, 11.2% Hispanics, 3.6% Asian or Pacific Islanders, 0.4% Native Americans, and 3.7% others. After adjusting for covariates, black patients (OR 0.637, 95% CI 0.625 to 0.648) and Hispanic patients (OR 0.654, 95% CI 0.641 to 0.667) had lower odds of treatment compared with white patients. Medicare patients had higher odds of treatment than private patients, while Medicaid and uninsured patients had lower odds. Interaction analysis showed that non-white/Hispanic patients with any insurance/no insurance had lower treatment odds than white patients. Multivariable regression analysis showed that the treatment odds of black patients has improved slightly over time, while the odds for Hispanic patients and other minorities have remained the same over time.

Conclusion This study from 2000 to 2019 shows that disparities in the treatment of UIA have persisted but have slightly improved over time for black patients while remaining constant for Hispanic patients and other minority groups.

  • flow diverter
  • CT angiography
  • aneurysm
  • angiography

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Conception/design of the work: SK, AS, BG, HC, PS. Data acquisition: SK, BG, DT, GW. Analysis of the data: SK, RB, AS. Interpretation of the data: SK, AS, BG, PS, WCN, EM, JC, JK, DT, GW. Drafting the work or critical revision: SK, BG, DT, GW, AS, PS, WCN, EM, JC, JK, HC. Study supervision: BG, HC. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work: All authors. SK and BG are guarantors of the study.

  • Funding Supported in part by U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds the Louisiana Clinical and Translational Science Center.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.