Article Text
Abstract
Introduction This study examines various socioeconomic variables and their role in mechanical thrombectomy (MT) outcomes among acute ischemic stroke patients across both coal-mining and non-coal-mining counties in the State of Kentucky. By comparing these two county types, the study aims to highlight modifiable socioeconomic disparities and devise targeted interventions to mitigate inequalities in stroke care delivery.
Methods A retrospective analysis of a prospectively collected database was conducted, encompassing all MT interventions for large vessel occlusion from 2015 to 2022 at a Comprehensive Stroke Center. Patients were stratified by county, with coal-production status as the primary variable. Chi-square and Fisher’s exact tests were used to analyze categorical variables, with significance set at P<0.05. Data on median income, rurality, food insecurity, as well as mental and physical disability were retrieved from county census data.
Results Coal county residents (n=275) had lower median incomes ($36,775 ± $5,046 vs. $52,060 ± $10,337, p<0.0001), greater rurality (74.5% ± 17.5 vs. 49% ± 33, p<0.0001), and higher instances of physical (19.6% ± 1.5 vs. 15.9% ± 2.7, p<0.0001) and mental distress (20.2% ± 1.2 vs. 17.3% ± 2.1, p<0.0001). Food insecurity (20.3% ± 2.9 vs. 15.1% ± 2.9, p<0.0001) and disparities in primary care access (171.6 ± 79.8 vs. 133.7 ± 86, p<0.0001) were more common, with a stark increase in the average distance from healthcare facilities (106 ± 29 miles vs. 39.6 ± 32.3 miles, p<0.0001).
Health outcomes following thrombectomy revealed longer infarct times in coal county residents (599.8 ± 322.1 minutes vs. 454.8 ± 275 minutes, p<0.0001) and higher NIHSS scores at admission (18.2 ± 7.8 vs. 16.8 ± 7.7, p=0.0233) and at discharge (9.3 ± 8 vs. 7.1 ± 6.6, p=0.0011). Although racial demographics showed significant differences (non-white: 2% vs. 9%, p<0.0001), indicating disparities, variables such as ICU/hospital stay durations and ventilator days did not reach statistical significance. Insurance coverage and mortality rates (in-hospital: 17% vs. 16%, p=0.6688; 90-day: 29% vs. 23%, p=0.1203), along with changes in NIHSS (49.2% ± 39.6 vs. 54.6% ± 40.4, p=0.1379) and mRS scores at discharge (3.9 ± 1.6 vs. 3.7 ± 1.7, p=0.3422), also did not show statistical significance.
Conclusion This study highlights the impact of social determinants on stroke outcomes, showing that while thrombectomy is effective, patients from disadvantaged backgrounds still face worse outcomes due to underlying health challenges. This underscores the importance of comprehensive care strategies that extend beyond acute treatment.
Disclosures Z. Al-Sharshahi: None. A. Parisi: None. H. Ahmad: None. A. Yaacoub: None. E. Franz: None. A. McAtee: None. F. Horne: None. A. Antuna: None. M. Abd: None. Z. Knox: None. J. Frank: None. K. Pennypacker: None. M. Al-Kawaz: None. S. Pahwa: None. J. Fraser: None. D. Dornbos: None.