Abstract Number ‐ 160: Insurance Status as a Predictor of Outcome in Mechanical Thrombectomy

Abstract

Introduction Multiple studies have shown socioeconomic disparities in accessing treatment for acute ischemic stroke. Recent studies revealed that mechanical thrombectomy (MT) is more likely to be performed in patients with commercial insurance compared to other insurance types (Medicare, Medicaid, and uninsured). Insurance status can be used as a proxy for the patient’s socioeconomic status (SES), however, limited published data is not indicative of significant influence of SES on outcomes. We aimed to compare outcomes of MT in association with patients’ primary insurance. Methods Patients who received mechanical thrombectomy at our institution between 2019 and 2022 were reviewed and categorized according to their insurance status with the following parameters: commercial insurance, Medicare, Medicaid, and uninsured. Baseline and outcome data including demographic characteristics, past medical history, and unfavorable outcome (defined by 3–6 on the 90‐day modified Rankin Scale) were assessed. Results Insurance status was available for 172 patients, 55% of which had Medicare as their primary payer, 19% had commercial insurance, 17% had Medicaid, and 9% were uninsured. The mean age was 64.9 years; uninsured 55.4, Medicaid 52.2, commercial 55.3. Patients on Medicare were significantly older at 73.9 (F = 48.94, p< 0.001). Post‐hoc tests showed that those with Medicare were significantly older than those who had commercial insurance, Medicaid, or were uninsured (p< 0.001 for each post‐hoc comparison). Multivariate logistic regression revealed that, compared to those with commercial insurance, those with Medicare had lower odds of having an unfavorable mRS at 90 days (aOR = 0.28, 95% CI = 0.10‐0.80). There were no significant differences for those uninsured or on Medicaid. Conclusions Patients with Medicare as their primary payer were found to have 72% lower odds of poor functional outcome at 90 days compared to those with commercial insurance, however, patients undergoing MT at our site were primarily Medicare eligible. These results are promising because they highlight non‐inferior outcomes with Medicaid and superior outcomes with Medicare compared to commercial insurance despite previous studies reporting limited access to MT.