Sex and Economic Disparity Related to Reperfusion Therapies for Patients with Acute Ischemic Stroke in South Korea across a 10-Year Period: A Nationwide Population-Based Study Using the National Health Insurance Database.

Jusun Moon,Jeoungbin Choi,Kwang-Pil Ko,Jeehye Lee,Jinyoung Shin,Jaehyeong An,Ho Jin Jeong,Sung Hyun Jo,Hyeongsu Kim

doi:10.3390/ijerph19053050

Abstract

A complete enumeration study was conducted to evaluate trends related to reperfusion therapies (intravenous thrombolysis (IVT) and endovascular treatment (EVT)) in acute ischemic stroke (AIS) in South Korea, according to sex, economic status, and age, over a 10-year period retrospectively, using the National Health Information Database (NHIS-2020-1-481). This study included AIS patients aged ≥20 years who were hospitalized in a general hospital or tertiary hospital for ≥4 days and underwent brain imaging during the same period. Study participants were classified by sex, economic status (Medical Aid beneficiaries and National Health Insurance beneficiaries) and age (20–44, 45–64, 65–79, and ≥80 years). Women showed a significantly lower OR (Odds ratio) than men in IVT (OR: 0.75; 95% CI: 0.73–0.77), EVT (OR: 0.96; 95% CI: 0.93–0.99), and any therapy (OR: 0.82; 95% CI: 0.80–0.84). The Medical Aid beneficiaries showed significantly lower OR in IVT (OR 0.91, 95% CI 0.88–0.95), EVT (OR 0.93, 95% CI 0.89–0.98), and either therapy (OR 0.92, 95% CI 0.90–0.95) than the National Health Insurance beneficiaries. This study showed sex and economic disparity related to reperfusion therapies in patients with AIS in Korea.

Highlights

Reperfusion therapies for acute ischemic stroke (AIS) consist of intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator and endovascular treatment (EVT), which removes the thrombus-causing large vessel occlusion from the body through a stentreiver or suction catheter
Public Health 2022, 19, 3050 not arrive at a hospital within 90 min [7]. These findings indicate a disparity in accessibility to reperfusion therapies for AIS patients
Regarding IVT, EVT, and either therapy, the odds ratio (OR) of patients aged ≥80 years against those aged

Summary

Introduction

Reperfusion therapies for acute ischemic stroke (AIS) consist of intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator and endovascular treatment (EVT), which removes the thrombus-causing large vessel occlusion from the body through a stentreiver or suction catheter. Accessibility to the reperfusion therapies, which affects the prognosis after AIS, differs by country [1–3], sex [4], race, economic status [5,6], and urban–. In South Korea, major studies on the treatment of AIS were mostly based on data from hospitals in urban areas; single-center studies [8]. Multicenter data [2] did not reveal differences in reperfusion therapy by sex and economic status. In nationwide reports, significant differences in the rates of IVT in AIS and the use of ambulances in all stroke cases by region were found [2]. The reperfusion therapy rate was very low in patients living in areas from which they could.

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