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Socioeconomics
Original research
Racial and economic disparities in the access to treatment of unruptured intracranial aneurysms are persistent problems
  1. Lorenzo Rinaldo1,
  2. Alejandro A Rabinstein2,
  3. Harry J Cloft2,
  4. John M Knudsen3,
  5. Giuseppe Lanzino1,3,
  6. Leonardo Rangel Castilla1,3,
  7. Waleed Brinjikji1,3
  1. 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Waleed Brinjikji, Department of Neurosurgery, Mayo Clinic, Rochester, MN 55902, USA; Brinjikji.Waleed{at}mayo.edu

Abstract

Background and purpose Previous studies have documented disparate access to cerebrovascular neurosurgery for patients of different racial and socioeconomic backgrounds. We further investigated the effect of race and insurance status on access to treatment of unruptured intracranial aneurysms (UIAs) and compared it with data on patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods Through the use of a national database, admissions for clipping or coiling of an UIA and for aSAH were identified. Demographic characteristics of patients were characterized according to age, sex, race/ethnicity, and insurance status, and comparisons between patients admitted for treatment of an UIA versus aSAH were performed.

Results There were 10 545 admissions for clipping or coiling of an UIA and 33 166 admissions for aSAH between October 2014 and July 2018. White/non-Hispanic patients made up a greater proportion of patients presenting for treatment of an UIA than those presenting with aSAH (64.3% vs 48.2%; P<0.001), whereas black/Hispanic patients presented more frequently with aSAH than for treatment of an UIA (29.3% vs 26.1%; P=0.006). On multivariate linear regression analysis, the proportion of patients admitted for management of an UIA relative to those admitted for aSAH increased with the proportion of patients who were women (P<0.001) and decreased with the proportion of patients with a black/Hispanic background (P=0.010) and those insured with Medicaid or without insurance (P=0.003).

Conclusion For patients with UIAs, racial, ethnic, and socioeconomic backgrounds appear to continue to influence access to treatment.

  • aneurysm
  • subarachnoid
  • hemorrhage

https://doi.org/10.1136/neurintsurg-2018-014626

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors LR: study conception and design, data collection, statistical analysis, drafting the manuscript, critical revision of the manuscript, and approved the final manuscript. AAR, HJC, JMK, GL, LRC, and WB: study conception and design, critical revision of the manuscript, and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

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