Associations between Canadian deprivation indices and acute stroke outcomes post endovascular thrombectomy - A retrospective cohort study.

BackgroundSocioeconomic status (SES) has long been recognized as an important determinant of ischemic stroke outcomes, with increased stroke severity and mortality found in patients with lower SES. However, the impact of SES on outcomes post-endovascular thrombectomy in Canada remains largely unknown.MethodsThis study is a retrospective cohort analysis of patients from 2015-2024 who received endovascular thrombectomy for large vessel occlusion in Manitoba, Canada (study catchment area 650,000 km2, population 1.4 million). Patient residence postal codes were matched with neighborhood-level socioeconomic factors using the Canadian Material and Social Deprivation Index and the Canadian Index of Multiple Deprivation (CIMD). Regression analyses adjusting for baseline demographics, geographic variables, presenting National Institutes of Health Stroke Scale (NIHSS), and time to angiography were conducted to analyze the association between socioeconomic factors and a binarized 90-day modified Rankin Scale (mRS).ResultsOverall, 793 patients (51% females, median age 74 years) were included. Unadjusted analyses showed a positive association between poor clinical outcomes and increased economic dependency scores in the CIMD index (OR = 1.18 [95%CI 1.03, 1.37]), as well as decreased CIMD ethno-cultural composition scores (OR = 0.84 [0.73-0.98]). Adjusted analysis did not show consistent associations between procedural outcomes or functionally independent outcomes at 90 days.InterpretationThis Canadian provincial stroke registry study showed SES-related discrepancies in stroke outcomes on an unadjusted basis, but no definite discrepancies after adjustment for age, presenting severity, and time to angiography. These findings suggest that SES-related differences in these variables mediate the observed relationship between SES and poor clinical outcomes.