Socioeconomic Deprivation in Ischemic Stroke Treated With Endovascular Thrombectomy: Not All Recoveries Are Equal.

BACKGROUND

The influence of socioeconomic deprivation on outcomes in ischemic stroke patients treated with thrombectomy remains unclear.

METHODS

We analyzed 6219 patients with ischemic stroke treated with thrombectomy between 2016 and 2023 in Catalonia, Spain. Socioeconomic deprivation was defined at the health care service area level (n=378) as the proportion of inhabitants with an annual income below $21 000. The adjusted absolute difference in the proportion of patients achieving good functional outcome (90-day modified Rankin Scale score of 0-2) between the least and most deprived areas (fifth versus 95th percentile) was estimated based on mixed effects modeling. Secondary outcomes included mortality at 90 days, 24-hour National Institutes of Health Stroke Scale score, complete reperfusion, and onset to arterial puncture time. Analyses were stratified by reference center location-Barcelona metropolitan region (fully covered by thrombectomy-capable centers) and Catalonia provincial region (dispersed population with varying center capabilities, including 3 thrombectomy-capable centers). The contribution of deprivation to between-center variance was estimated using a between-within effects model.

RESULTS

Patients from most deprived areas were less likely to achieve functional independence in metropolitan (adjusted absolute difference, 7.4% [95% CI, 2.1%-12.7%]; P<0.01) than provincial (adjusted absolute difference, 10% [95% CI, 2.8%-17.2%]; P<0.01) regions. Mortality rate, complete reperfusion, and 24-hour National Institutes of Health Stroke Scale score did not differ between areas, whereas time from onset to thrombectomy was delayed in most deprived areas of the provincial region (least deprived 226 minutes [95% CI, 196-256] versus most deprived 272 minutes [95% CI, 247-298], difference 46 minutes [95% CI, 3-90]; P=0.02). Average center-level socioeconomic deprivation explained a substantial proportion of between-center variability in good functional outcomes, particularly in the metropolitan region.

CONCLUSIONS

Socioeconomic deprivation is a major determinant of poor functional outcomes in patients with stroke undergoing endovascular thrombectomy in Catalonia, Spain, explaining a substantial proportion of between-center differences in outcomes. This disparity may be partially attributed to delays in acute treatment; however, postacute care factors should be evaluated as key contributors.