Hospital Implementation of Endovascular Thrombectomy and Health Equity in Acute Stroke Outcomes

BACKGROUND: The introduction of novel therapeutics into clinical practice could impact equity in health outcomes. METHODS: This was a retrospective, observational cohort study based on the Get With The Guidelines-Stroke program of the American Heart Association. Two epochs were considered: January 2010 to December 2014 and January 2016 to December 2019. The primary exposure was the availability of endovascular thrombectomy (EVT) at the hospital level defined by the degree of implementation of EVT (>10% change from pre-2015 to post-2015) after balancing key patient and hospital characteristics with overlap weighting. The coprimary end points were (1) the difference in in-hospital mortality for patients from counties with median income >60 000 versus 60 000 versus <60 000 (absolute risk difference, 3. 9% 95% CI, 0. 53%–7. 3%). Implementation of EVT was not associated with changes in differences in in-hospital mortality by race, sex, county poverty rates, county educational attainment, or insurance status. CONCLUSIONS: Among patients with acute ischemic stroke who were potentially eligible for EVT, the implementation of EVT on a hospital level did not worsen health equity in any dimension (race/ethnicity, sex, or insurance status) and was associated with improvements in socioeconomic equity in acute ischemic stroke mortality.