Are there socio-economic inequities in access to reperfusion therapy: The stroke 69 cohort - 15/07/21

Doi : 10.1016/j.neurol.2021.02.394

A. Perrin ^a,⁎ , J. Freyssenge ^a,^b, J. Haesebaert ^a,^c, K. Tazarourte ^a,^d, A. Termoz ^a,^c, O. Grimaud ^e, L. Derex ^a,^f, M. Viprey ^a,^c, A.M. Schott ^a,^c
^a Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
^b RESUVal – Réseau des Urgences de la Vallée du Rhône, 38200 Vienne, France
^c Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
^d Service des urgences, hospices civils de Lyon, 69003 Lyon, France
^e EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, université de Rennes, 35000 Rennes, France
^f Service de neurologie vasculaire, hospices civils de Lyon, 69500 Bron, France

^⁎Corresponding author. Université Claude Bernard Lyon 1, site Rockefeller, 8, avenue Rockefeller, 69008 Lyon, France.Université Claude Bernard Lyon 1, site Rockefeller8, avenue RockefellerLyon69008France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 15 July 2021
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Highlights

•	Implementation of endovascular thrombectomy in a population-based cohort is not associated with increase access inequities.
•	Inequities is measured by an ecological index constructed with a multidimensionality of socioeconomic characteristics assumes that inequities are related to social and environmental influences.

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Abstract

Background and purpose

Low socio-economic status of individuals has been reported to be associated with a higher incidence of stroke and influence the diagnosis after revascularization. However, whether it is associated with poorer acute stroke management is less clear. To determine whether social deprivation was associated with a poorer access to reperfusion therapy, either intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) in a population-based cohort.

Methods

Over a 14-month period, all consecutive adult patients admitted to any emergency department or a comprehensive or primary stroke center (CSC/PSC) of the Rhône county with a confirmed ischemic stroke were included. The socioeconomic status of each patient was measured using the European Deprivation Index (EDI). The association between EDI and access to reperfusion therapy was assessed in univariate and multivariate logistic regression analyses.

Results

Among the 1226 consecutive IS patients, 316 (25%) were admitted directly in a PSC or CSC, 241 (19.7%) received a reperfusion therapy; 155 IVT alone, 20 EVT alone, and 66 both therapies. Median age was 79 years, 1030 patients had an EDI level of 1 to 4, and 196 an EDI of 5 (the most deprived group). The most deprived patients (EDI level 5) did not have a poorer access to reperfusion therapy compared to all other patients in univariate (OR 1.22, 95%CI [0.85; 1.77]) nor in multivariate analyses (adjOR 0.97, 95%CI [0.57; 1.66]).

Conclusions

We did not find any significant association between socioeconomic deprivation and access to reperfusion therapy. This suggests that the implementation of EVT was not associated with increased access inequities.

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Keywords : Social deprivation, Stroke, Reperfusion, Thrombolytic therapy, Thrombectomy, Cohort study