• Ganesh Asaithambi, Xin Tong, Kamakshi Lakshminarayan, Coleman King Sallyann M SM Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States., and Mary G George.
• United Hospital Comprehensive Stroke Center, Allina Health, 310 North Smith Avenue, Suite 440, St. Paul, MN, United States. Electronic address: ganesh785@gmail.com.
• J Stroke Cerebrovasc Dis. 2021 May 1; 30 (5): 105692.

BackgroundStroke continues to be a leading cause of death and disability in the United States. Rates of intra-arterial reperfusion treatments (IAT) for acute ischemic stroke (AIS) are increasing, and these treatments are associated with more favorable outcomes. We sought to examine the effect of insurance status on outcomes for AIS patients receiving IAT within a multistate stroke registry.MethodsWe used data from the Paul Coverdell National Acute Stroke Program (PCNASP) from 2014 to 2019 to quantify rates of IAT (with or without intravenous thrombolysis) after AIS. We modeled outcomes based on insurance status: private, Medicare, Medicaid, or no insurance. Outcomes were defined as rates of discharge to home, in-hospital death, symptomatic intracranial hemorrhage (sICH), or life-threatening hemorrhage during hospitalization.ResultsDuring the study period, there were 486,180 patients with a clinical diagnosis of AIS (mean age 70.6 years, 50.3% male) from 674 participating hospitals in PCNASP. Only 4.3% of patients received any IAT. As compared to private insurance, uninsured patients receiving any IAT were more likely to experience in-hospital death (AOR 1.36 [95% CI 1.07-1.73]). Medicare (AOR 0.78 [95% CI 0.71-0.85]) and Medicaid (AOR 0.85 [95% CI 0.75-0.96]) beneficiaries were less likely but uninsured patients were more likely (AOR 1.90 [95% CI 1.61-2.24]) to be discharged home. Insurance status was not found to be independently associated with rates of sICH.ConclusionsInsurance status was independently associated with in-hospital death and discharge to home among AIS patients undergoing IAT.Copyright © 2021 Elsevier Inc. All rights reserved.

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