{
  "abstract": "Background Differences in access to and selection of treatment for unruptured intracranial aneurysms (UIAs) across racial and socioeconomic groups remain an important concern in the United States. Over the last several years, the management of UIAs has continued to evolve with growing use of endovascular techniques, including flow diverters, while the COVID-19 pandemic may also have influenced patterns of care. We therefore examined contemporary national trends in the treatment of UIA across race/ethnicity, income, and insurance status.Methods We used the 2018-2022 National Inpatient Sample to identify hospitalizations with a principal diagnosis of unruptured intracranial aneurysm in which patients underwent surgical clipping, coil embolization, or flow-diverter-based treatment with or without coiling. National estimates were generated using survey weights. Patient demographics, race/ethnicity, ZIP code income quartile, primary payer, and hospital characteristics were compared overall and across the pre-COVID, COVID, and post-COVID periods.Results A total of 22,805 weighted UIA hospitalizations met study criteria. Most patients were women (68.2%), and nearly three-quarters were between 50 and 79 years of age (72.6%). Overall, 64.2% of patients were White, 14.6% Black, 13.1% Hispanic, 3.6% Asian/Pacific Islander, 0.8% Native American, and 3.7% Other. Socioeconomically, 25.6% of patients resided in the lowest income quartile, while 22.5% were from the highest quartile. The most common payers were private insurance (38.7%), Medicare (37.9%), and Medicaid (15.1%). Over time, the racial composition of treated UIA patients changed significantly (p=0.003): the proportion of White patients fell from 67.2% in the pre-COVID era to 60.4% in the post-COVID era, while Black patients increased from 13.3% to 16.1%. Smaller increases were also seen among Hispanic patients (12.7% to 14.2%) and Asian/Pacific Islander patients (2.4% to 4.5%). In contrast, income (p=0.30) and payer (p=0.50) distributions were largely unchanged across eras. With regard to treatment, 41.9% underwent clipping, 49.6% underwent coiling, and 8.6% underwent flow-diverter-based therapy. Treatment choice varied significantly by race/ethnicity (p=0.036): Black patients were more likely than White patients to undergo clipping (45.5% vs 41.2%), whereas Asian/Pacific Islander patients most commonly underwent coil-only treatment (58.8%).Conclusions In this contemporary national cohort of patients with a principal diagnosis of UIA treated by clipping, coiling, or flow-diverter-based therapy, we found modest but significant racial differences in treatment selection, along with a gradual shift toward greater racial diversity over time. By contrast, income and payer status appeared to have a more limited relationship with treatment modality.Disclosures K. Gupta: None. M. Karsy: None. D. Altschul: None.Abstract E-174 Table 1Key demographic, socioeconomic, COVID-era, and treatment modality patterns among treated unruptured intracranial aneurysm hospitalizations (nis 2018-2022)",
  "authors": [
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "K Gupta"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan, Lansing, MI"
      ],
      "name": "M Karsy"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Florida, Gainesville, FL"
      ],
      "name": "B Lucke-Wold"
    },
    {
      "affiliations": [
        "The Leo M. Davidoff Department of Neurological Surgery Team, Albert Einstein School of Medicine, Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-174 Racial, socioeconomic, and COVID-era patterns in treatment modality for unruptured intracranial aneurysms in the united states, 2018-2022",
  "uid": "15d32805-3607-5553-973d-8dd6f4fd85ec"
}