Evidence map›Paper›PMID 37914415›Full record

ArticleNeurology2023

Association of Neighborhood Deprivation With Thrombolysis and Thrombectomy for Acute Stroke in a Health System With Universal Access.

Foad Taghdiri, Manav V Vyas, Moira K Kapral, Lauren Lapointe-Shaw, Peter C Austin, Preston Tse, Joan Porter, Yue Chen, Jiming Fang, Amy Ying Xin Yu

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Hospital Socioeconomic Status and Acute Stroke Treatment in the United States.Cerebrovascular diseases (Basel, Switzerland) · 2026
    Article
  6. Article
  7. Article
  8. Associations between Canadian deprivation indices and acute stroke outcomes post endovascular thrombectomy - A retrospective cohort study.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025
    Article
  9. Observational
  10. Article
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Foad TaghdiriFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0002-3280-2804
Manav V VyasFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0002-2953-2540
Moira K KapralFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0002-3444-9928
Lauren Lapointe-ShawFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0003-4485-6719
Peter C AustinFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0003-3337-233X
Preston TseFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0009-0001-9273-1366
Joan PorterFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.
Yue ChenFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0009-0001-2387-6684
Jiming FangFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada.ORCID 0000-0002-4526-0987
Amy Ying Xin YuFrom the Division of Neurology (F.T., M.V.V., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Research Institute (M.V.V.), St. Michael's Hospital-Unity Health Toronto; Institute of Health Policy, Management and Evaluation (M.V.V., M.K.K., P.C.A., A.Y.X.Y.) and Division of General Internal Medicine (M.K.K., L.L.-S.), Department of Medicine, University of Toronto; Toronto General Research Institute (M.K.K., L.L.-S.), University Health Network; ICES (M.K.K., L.L.-S., P.C.A., J.P., Y.C., J.F., A.Y.X.Y.); Sunnybrook Research Institute (M.K.K., P.C.A., A.Y.X.Y.), Toronto; and McMaster University (P.T.), Hamilton, Ontario, Canada. amyyx.yu@utoronto.ca.ORCID 0000-0002-7276-9551

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

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

methodsWe conducted a population-based cohort study using linked administrative data from Ontario, Canada. This 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. Furthermore, we tested whether hospital type modified the associations between deprivation and outcomes.

resultsAmong 57,704 patients, those in the most materially deprived group (quintile 5) were less likely to be treated with thrombolysis or thrombectomy compared with those in the least deprived group (quintile 1) (16.6% vs 19.6%, adjusted odds ratio [aOR] 0.76, 95% CI 0.63-0.93). The association was consistent when evaluating thrombolysis (13.0% vs 15.3%, aOR 0.78, 95% CI 0.64-0.96) and thrombectomy (6.4 vs 7.8%, aOR 0.73, 95% CI 0.59-0.90) separately. There were no statistically significant differences between the middle 3 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 ( DISCUSSION: We observed disparities in the use of thrombolysis or thrombectomy for acute ischemic stroke by socioeconomic status despite access to universal health care. Targeted health care policies, public health messaging, and resource allocation are needed to ensure equitable access to acute stroke treatments for all patients.

Indexed as

Brain IschemiaIschemic StrokeStrokeAdultCohort StudiesHumansOntarioThrombectomyThrombolytic TherapyTreatment Outcome

Identifiers

PMID37914415
PMCPMC10727218

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.