Updated Trends, Disparities, and Clinical Impact of Neuroimaging Utilization in Ischemic Stroke in the Medicare Population: 2012 to 2019
The purpose of this study was to update trends, investigate sociodemographic disparities, and evaluate the impact on mortality of stroke neuroimaging across the United States from 2012 to 2019. Retrospective cohort study using CMS Medicare 5% Research Identifiable Files, representing consecutive isc...
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| Published in: | Journal of the American College of Radiology Vol. 19; no. 7; pp. 854 - 865 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Elsevier Inc
01-07-2022
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | The purpose of this study was to update trends, investigate sociodemographic disparities, and evaluate the impact on mortality of stroke neuroimaging across the United States from 2012 to 2019.
Retrospective cohort study using CMS Medicare 5% Research Identifiable Files, representing consecutive ischemic stroke emergency department or hospitalized patients aged ≥65 years. A total of 85,547 stroke episodes with demographic and clinical information were analyzed using Cochran-Mantel-Haenszel tests and logistic regression. Outcome measures were neuroimaging (CT angiography [CTA], CT perfusion [CTP], MRI, MR angiography [MRA]) utilization, acute treatment (endovascular thrombectomy [EVT] and intravenous thrombolysis [IVT]), and mortality while in the hospital and at 30 days and 1 year post discharge.
Significantly increasing utilization trends for CTA (250%), CTP (428%) and MRI (18%), and a decreasing trend for MRA (−33%) were observed from 2012 to 2019 (P < .0001). Controlling for covariates in the logistic regression models, CTA and CTP were significantly associated with higher EVT and IVT utilization. Although CTA, MRI, and MRA were associated with lower mortality, CTP was associated with higher mortality post discharge. Less neuroimaging was performed in rural patients; older patients (≥80 years) had lower utilization of CTA, MRI, and MRA; female patients had lower rates of CTA; and Black patients had lower utilization of CTA and CTP.
CTA and CTP utilization increased in the Medicare ischemic stroke population from 2012 to 2019 and both were associated with greater EVT and IVT use. However, disparities exist in neuroimaging utilization across all demographic groups, and further understanding of the root causes of these disparities will be crucial to achieving equity in stroke care. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Disclosure statement: None Disclosure statement: Dr. Katz has received grants from Siemens Healthineers and NINDS during the conduct of the study. Psanelli@northwell.edu Jason J. Wang, PhD, academic affiliation non-partnership track employee jhemingway@neimanhpi.org Artem Boltyenkov, PhD, MBA, academic affiliation non-partnership track employee, Visiting Scholar at the Feinstein Institutes for Medical Research Substantially contributed to the conception and design of the studySubstantially contributed to the data curation and organizationSubstantially contributed to the statistical analysesSubstantially contributed to the writing and revision of the manuscriptApproved the final version of the manuscriptAccountable for the manuscript's contents Director, Neuroendovascular Surgery, South Shore University Hospital The Harvey L. Neiman Health Policy Institute, Reston, VA Substantially contributed to the conception and design of the studySubstantially contributed to the data supervisionSubstantially contributed to the writing and revision of the manuscriptApproved the final version of the manuscriptAccountable for the manuscript's contents Disclosure statement: Dr. Wang has received grants from Siemens Healthineers and NINDS during the conduct of the study. Jeffrey M. Katz, MD, academic affiliation non-partnership track employee Director, Comprehensive Stroke Center and Stroke Unit, North Shore University Hospital JKatz2@northwell.edu Pina C. Sanelli, MD, MPH, FACR, academic affiliation non-partnership track employee, Vice Chair of Research, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Substantially contributed to the conception and design of the studySubstantially contributed to the data curation and organizationSubstantially contributed to the statistical analysesSubstantially contributed to the writing and revision of the manuscriptApproved the final version of the manuscriptAccountable for the manuscript's contents Associate Professor and Health Economist Neurology Service Line Director, Neuroendovascular Surgery Associate Professor of Neurology & Radiology Disclosure statement: Dr. Boltyenkov reports personal fees from Siemens Medical Solutions USA, Inc., outside the submitted work, and is a shareholder of Siemens Healthineers. cpelzl@neimanhpi.org Zucker School of Medicine at Hofstra/Northwell Substantially contributed to the conception and design of the studySubstantially contributed to the data supervisionSubstantially contributed to the writing and revision of the manuscriptApproved the final version of the manuscriptAccountable for the manuscript's contents Jennifer Hemingway, MS, academic affiliation non-partnership track employee, Senior Research Associate Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Substantially contributed to the conception and design of the studySubstantially contributed to the data curation and organizationSubstantially contributed to the statistical analysesSubstantially contributed to the revision of the manuscriptApproved the final version of the manuscriptAccountable for the manuscript's contents Disclosure statement: Dr. Sanelli received research grants from Siemens Healthineers and NINDS during the conduct of the study and research grants from the Harvey L. Neiman Health Policy Institute outside the submitted work Author’s employment status, leadership positions, roles on this study and disclosure statements echristensen@neimanhpi.org jwang11@northwell.edu Casey E. Pelzl, MPH, academic affiliation non-partnership track employee, Biostatistician erula@neimanhpi.org Eric W. Christensen, PhD, academic affiliation non-partnership track employee, Principal Research Scientist Chief, Neurovascular Services and artem.boltyenkov@siemens-healthineers.com Elizabeth Rula, PhD, academic affiliation non-partnership track employee, Executive Director |
| ISSN: | 1546-1440 1558-349X |
| DOI: | 10.1016/j.jacr.2022.03.008 |