Association of neighborhood deprivation with thrombolysis and thrombectomy for acute stroke in a health system with universal access

Background and Objectives — The association between socioeconomic status and acute ischemic stroke treatments remain uncertain, particularly in countries with universal healthcare systems. This study aimed to investigate the association between neighborhood-level material deprivation and the odds of receiving intravenous thrombolysis or thrombectomy for acute ischemic stroke within a single-payer, government-funded healthcare system.

Methods — We conducted a population-based cohort study using linked administrative data from Ontario, Canada. The study involved all community-dwelling adult Ontario residents hospitalized with acute ischemic stroke between 2017 and 2022. Neighborhood-level material deprivation, measured in quintiles from least to most deprived, was our main exposure. We considered the receipt of thrombolysis or thrombectomy as the primary outcome. We used multivariable logistic regression models adjusted for baseline differences to estimate the association between material deprivation and outcomes. We performed a sensitivity analysis by additionally adjusting for hospital type at initial assessment. Further, we tested whether hospital type modified the associations between deprivation and outcomes.

Results — Among 57,704 patients, those in the most materially deprived group (Quintile 5) were less likely to be treated with thrombolysis or thrombectomy compared to those in the least deprived group (Quintile 1), 16.6% vs 19.6%, adjusted odds ratio (aOR) 95% confidence interval 0.76 [0.63, 0.93]. The association was consistent when evaluating thrombolysis (13.0% vs 15.3%, aOR 0.78 [0.64, 0.96]) and thrombectomy (6.4 vs 7.8%, aOR 0.73 [0.59, 0.90]) separately. There were no statistically significant differences between the middle three quintiles and the least deprived group. These associations persisted after additional adjustment for hospital type and there was no interaction between material deprivation and hospital type (p-interaction > 0.1).

Discussion — We observed disparities in the use of thrombolysis or thrombectomy for acute ischemic stroke by socioeconomic status despite access to universal healthcare. Targeted healthcare policies, public health messaging, and resource allocation are needed to ensure equitable access to acute stroke treatments for all patients.