Objective: We analyzed whether socioeconomic factors affected utilization of stroke neuroimaging and acute treatment at a comprehensive stroke center.

Methods: Retrospective study of consecutive acute ischemic stroke patients at a metropolitan comprehensive stroke center from 2012-2020 was performed. Differences in neuroimaging (CTA, CTP, MRI, MRA) and treatment (intravenous thrombolysis – IVT, endovascular thrombectomy – EVT) utilization were evaluated based on socioeconomic factors of age, sex, race, insurance-type, and household income. Chi-square tests were used for bivariate analyses. A multivariable logistic regression model was fit to determine associations between socioeconomic factors and neuroimaging and treatment utilization while controlling for medical comorbidities and stroke-specific factors.

Results: The cohort comprised 6,140 consecutive AIS discharges from our institution during the study period. It had 47.6% female; 59.5% white, 16.6% Black, and 10.6% Asian; with 65.2% having private insurance, 52.7% Medicare, 12.9% Medicaid, and 2.1% uninsured. The mean (SD) age was 70.5 (15.1) years, NIHSS 7.4 (7.9), and Last-Known-Well to Admission 18.2 (31.1) hours. The most common comorbidities were hypertension (69.1%), dyslipidemia (40.9%), obesity (35.2%), and diabetes mellitus (30.8%), while 18.5% had prior stroke. 80+ year-old patients had lower CTA (OR=0.62 [0.51-0.75]) and EVT utilization (OR=0.53 [0.39-0.73]), while female patients had lower CTA utilization (OR=0.78 [0.65-0.93]), but equal treatment. All races had equivalent CTA, CTP, and MRA utilization, and odds of acute stroke treatment. While privately insured patients had higher utilization of MRA (OR=1.24 [1.04-1.49]) and EVT (OR=1.62 [1.20-2.20]), uninsured patients had higher MRI utilization (OR=1.64 [1.07-2.50]).

Conclusions: Patients 80 years old and older had lower utilization of both CTA and EVT, while female patients had less CTA utilization, but equal acute stroke treatment. All races had equal utilization of acute stroke treatment and all other neuroimaging modalities. We found significantly fewer disparities in stroke imaging or acute treatment utilization than prior studies.