Racial and socioeconomic disparities in the treatment of unruptured intracranial aneurysms: A county hospital experience.

With increasing prevalence of unruptured intracranial aneurysms (UIAs), there is a need to provide appropriate management. Several studies have suggested that minorities in the United States have limited access to non-invasive imaging leading to increased presentation of aneurysmal subarachnoid hemorrhages (aSAHs). Given our medical institution's commitment to ensuring racial equality within our health care system, we chose to analyze our practice to assess the utilization of care provided by our neuroendovascular team. We hypothesized that given our diverse neuroendovascular care team along with our dedication to equity in healthcare, that we would find no difference in care provided to minority patients versus white patients who presented with UIAs. We conducted a retrospective electronic medical record-based review of all patients with UIAs (n = 140) between September 2010 and June 2022 treated at a county hospital. Data regarding age at the time of treatment, gender, race, insurance type and aneurysm location were obtained. Of the 140 patients that underwent treatment, 54 % of patients were from the Black/Hispanic group and 46 % were from the white/non-Hispanic group. Commercial/private insurance was more common among White/NonHispanic patients (57.7 % vs 51.4 %) whereas Medicaid or uninsured status was more common among Black/Hispanic patients (25.7 % vs 15.4 %), although these differences were not statistically significant. Building a diverse neuroendovascular physician team with intentionality to equity in healthcare, and providing appropriate funding and resources to facilities used by marginalized populations, such as safety-net institutions, can mitigate minority patients' limited access to intracranial aneurysmal care.

Smith T ，Wormmeester K ，Attia J ，Martinez M ，Useche N ，Tejada J ... -  《-》

Racial and ethnic disparities in the treatment of unruptured intracranial aneurysms: a study of the Nationwide Inpatient Sample 2001-2009.

Brinjikji W ，Rabinstein AA ，Lanzino G ，Cloft HJ ... -  《-》

Racial and economic disparities in the access to treatment of unruptured intracranial aneurysms are persistent problems.

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

Rinaldo L ，Rabinstein AA ，Cloft HJ ，Knudsen JM ，Lanzino G ，Rangel Castilla L ，Brinjikji W ... -  《-》

The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?

Shone LP ，Dick AW ，Brach C ，Kimminau KS ，LaClair BJ ，Shenkman EA ，Col JF ，Schaffer VA ，Mulvihill F ，Szilagyi PG ，Klein JD ，VanLandeghem K ，Bronstein J ... -  《-》

Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

Cruz-Flores S ，Rabinstein A ，Biller J ，Elkind MS ，Griffith P ，Gorelick PB ，Howard G ，Leira EC ，Morgenstern LB ，Ovbiagele B ，Peterson E ，Rosamond W ，Trimble B ，Valderrama AL ，American Heart Association Stroke Council ，Council on Cardiovascular Nursing ，Council on Epidemiology and Prevention ，Council on Quality of Care and Outcomes Research ... -  《-》