IMPACT OF THE SOCIOECONOMIC STATUS ON SURVIVAL AFTER ACUTE ISCHEMIC STROKE: A POPULATION-BASED STUDY IN A REGION WITH UNIVERSAL HEALTHCARE COVERAGE

Background: A heterogeneous patient population receives endovascular treatment (EVT) for acute ischemic stroke due to proximal large vessel occlusion every day. We aimed to conduct a population-based study of EVT in the province of Alberta, Canada, to understand the effectiveness in a complete population and how the magnitude of effect differs from the artificial world of clinical trials. Methods and Results: Within a three year period (April 2015 - March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. Primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at pre-morbid living situation without increase in level of care within 90 days of index stroke event. Median age of patients was 70 years (interquartile range (IQR) 59 - 81) and 47.8% were female. Median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13 - 20). EVT was associated with an increased 90-day home-time by an average of 8.5 days compared to medical treatment alone using Cragg hurdle regression (p = 0.009). Age and higher NIHSS score were associated with decreased 90-day home-time (both p = 0.001). Multivariable logistic regression showed no association between EVT and mortality at 90 days (odds ratio 0.76, 95% confidence interval 0.47 - 1.24). Conclusions: EVT for acute ischemic stroke due to proximal large vessel occlusion was effective in our province-wide population-based study and results in increased 90-day home-time by ~8.5 days. Home-time is a novel and patient-centered outcome that reflects health circumstances that are easy to understand and meaningful to patients and their caregivers.

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A population-based study for 30-d hospital readmissions after acute ischemic stroke

International Journal of Neuroscience ◽

10.1080/00207454.2016.1207642 ◽

2016 ◽

Vol 127 (4) ◽

pp. 305-313 ◽

Cited By ~ 7

Author(s):

Manoj K. Mittal ◽

Alejandro A. Rabinstein ◽

Jay Mandrekar ◽

Robert D. Brown ◽

Kelly D. Flemming

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hospital Readmissions ◽

Population Based ◽

Population Based Study

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Gender Differences in Presenting Signs and Symptoms of Acute Ischemic Stroke: A Population-Based Study

Gender Medicine ◽

10.1016/j.genm.2011.08.001 ◽

2011 ◽

Vol 8 (5) ◽

pp. 312-319 ◽

Cited By ~ 30

Author(s):

Nivedita U. Jerath ◽

Chandan Reddy ◽

W. David Freeman ◽

Aarti U. Jerath ◽

Robert D. Brown

Keyword(s):

Gender Differences ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Signs And Symptoms ◽

Population Based ◽

Population Based Study

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Universal Healthcare Coverage Does Not Ensure Adherence to Initial Colorectal Cancer Screening Guidelines

Military Medicine ◽

10.1093/milmed/usaa319 ◽

2020 ◽

Author(s):

Christian S McEvoy ◽

Nina G Shah ◽

Sarah E Roberts ◽

Anna M Carroll ◽

Timothy A Platz ◽

...

Keyword(s):

Colorectal Cancer ◽

Socioeconomic Status ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Active Duty ◽

Average Risk ◽

Screening Guidelines ◽

Universal Healthcare ◽

Healthcare Coverage ◽

Universal Healthcare Coverage

Abstract Introduction Colorectal cancer is the second leading cause of cancer deaths in the USA, and screening tests are underutilized. The aim of this study was to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system. Materials and Methods This is a retrospective cohort study of active duty and retired military members as well as civilian beneficiaries of the Military Health System. Individuals born from 1960 to 1962 and eligible for full benefits on their 50th birthday were evaluated. Military rank or rank of benefits sponsor was used to determine socioeconomic status. Adherence to the U.S. Preventive Services Task Force guidelines for initial colorectal cancer screening was determined using “Current Procedural Terminology” and “Healthcare Common Procedure Coding System” codes for colonoscopy, sigmoidoscopy, fecal occult blood test, and fecal immunohistochemistry test. Average risk individuals who obtained early screening ages 47 to 49 were also identified. Results This study identified 275,665 individuals at average risk. Of these, 105,957 (38.4%) adhered to screening guidelines. An additional 19,806 (7.2%) individuals were screened early. Colonoscopy (82.7%) was the most common screening procedure. Highest odds of screening were associated with being active duty military (odds ratio [OR] 3.63, 95% confidence interval [CI] 3.43 to 3.85), having highest socioeconomic status (OR 2.37, 95% CI 2.31 to 2.44), and having managed care insurance (OR 4.36, 95% CI 4.28 to 4.44). Conclusions Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities.

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