Racial and ethnic disparities in the treatment of unruptured intracranial aneurysms

A study of the nationwide inpatient sample 2001-2009

Waleed Brinjikji, Alejandro Rabinstein, Giuseppe Lanzino, Harry J. Cloft

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background and Purpose: Minorities in the United States have less access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and sex disparities existed in the treatment of unruptured intracranial aneurysms. Methods: Using the Nationwide Inpatient Sample, hospitalizations for clipping and coiling of intracranial aneurysms from 2001 to 2009 were identified by cross-matching International Classification of Diseases, 9th Revision codes for diagnosis of unruptured aneurysm and subarachnoid hemorrhage (SAH) with procedure codes for clipping or coiling of cerebral aneurysms. Demographic information analyzed included age (<50, 50-64, 65-79, and ≥80 years), race (white, black, Hispanic, Asian/Pacific Islander), sex, income quartile, primary payer (Medicare, Medicaid, private insurance, self-pay, no charge, other), and Charlson comorbidity index. Results: When compared with patients treated for SAH, those treated for unruptured intracranial aneurysm were significantly more likely to be women (75.0% versus 69.0%; P<0.0001). In all, 9.7% of patients receiving treatment for SAH were self-payers versus 3.0% of patients being treated for unruptured intracranial aneurysm (P<0.0001). In all, 62.2% of patients receiving treatment for SAH were white compared with 76.4% of patients being treated for unruptured intracranial aneurysm (P<0.0001). There was a higher proportion of black, Hispanic, and Asian patients in the SAH treatment group when compared with the unruptured aneurysm treatment group (P<0.0001 for all groups). Conclusions: When compared with patients undergoing treatment for SAH, patients undergoing surgical and endovascular treatment for unruptured intracranial aneurysm are generally from higher socioeconomic strata and are more likely to be insured, women, and white. Future studies are needed to determine the underlying causes and solutions for this disparity.

Original languageEnglish (US)
Pages (from-to)3200-3206
Number of pages7
JournalStroke
Volume43
Issue number12
DOIs
StatePublished - Dec 2012

Fingerprint

Intracranial Aneurysm
Inpatients
Subarachnoid Hemorrhage
Therapeutics
Hispanic Americans
Aneurysm
Medicaid
International Classification of Diseases
Medicare
Insurance
Comorbidity
Hospitalization
Demography
Delivery of Health Care

Keywords

  • Endovascular treatment
  • Interventional neuroradiology
  • Intracranial aneurysm
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Racial and ethnic disparities in the treatment of unruptured intracranial aneurysms : A study of the nationwide inpatient sample 2001-2009. / Brinjikji, Waleed; Rabinstein, Alejandro; Lanzino, Giuseppe; Cloft, Harry J.

In: Stroke, Vol. 43, No. 12, 12.2012, p. 3200-3206.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose: Minorities in the United States have less access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and sex disparities existed in the treatment of unruptured intracranial aneurysms. Methods: Using the Nationwide Inpatient Sample, hospitalizations for clipping and coiling of intracranial aneurysms from 2001 to 2009 were identified by cross-matching International Classification of Diseases, 9th Revision codes for diagnosis of unruptured aneurysm and subarachnoid hemorrhage (SAH) with procedure codes for clipping or coiling of cerebral aneurysms. Demographic information analyzed included age (<50, 50-64, 65-79, and ≥80 years), race (white, black, Hispanic, Asian/Pacific Islander), sex, income quartile, primary payer (Medicare, Medicaid, private insurance, self-pay, no charge, other), and Charlson comorbidity index. Results: When compared with patients treated for SAH, those treated for unruptured intracranial aneurysm were significantly more likely to be women (75.0{\%} versus 69.0{\%}; P<0.0001). In all, 9.7{\%} of patients receiving treatment for SAH were self-payers versus 3.0{\%} of patients being treated for unruptured intracranial aneurysm (P<0.0001). In all, 62.2{\%} of patients receiving treatment for SAH were white compared with 76.4{\%} of patients being treated for unruptured intracranial aneurysm (P<0.0001). There was a higher proportion of black, Hispanic, and Asian patients in the SAH treatment group when compared with the unruptured aneurysm treatment group (P<0.0001 for all groups). Conclusions: When compared with patients undergoing treatment for SAH, patients undergoing surgical and endovascular treatment for unruptured intracranial aneurysm are generally from higher socioeconomic strata and are more likely to be insured, women, and white. Future studies are needed to determine the underlying causes and solutions for this disparity.",
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