The 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.

We 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.

Among 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 (p interaction >0.1).

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.

社会经济地位与急性缺血性中风治疗之间的关联仍不确定，特别是在拥有全民医疗保健系统的国家。本研究旨在调查社区层面的物质匮乏与在单一支付者、政府资助的医疗保健系统内接受急性缺血性中风静脉溶栓或血栓切除术的几率之间的关联。

我们使用加拿大安大略省的相关行政数据进行了一项基于人群的队列研究。这项研究涉及 2017 年至 2022 年间因急性缺血性中风住院的所有社区居住的成年安大略居民。社区层面的物质匮乏（以五分位数从最不匮乏到最匮乏的程度）是我们的主要暴露。我们认为接受溶栓或血栓切除术是主要结局。我们使用根据基线差异进行调整的多变量逻辑回归模型来估计物质剥夺和结果之间的关联。我们通过在初始评估时额外调整医院类型来进行敏感性分析。此外，我们还测试了医院类型是否改变了剥夺与结果之间的关联。

在 57,704 名患者中，与最贫困组（五分位数 1）的患者相比，物质最贫困组（五分位数 5）的患者接受溶栓或血栓切除术的可能性较小（16.6% vs 19.6%，调整后优势比 [aOR] 0.76, 95% CI 0.63–0.93）。分别评估溶栓（13.0% vs 15.3%，aOR 0.78，95% CI 0.64–0.96）和血栓切除术（6.4 vs 7.8%，aOR 0.73，95% CI 0.59–0.90）时，这种关联是一致的。中间三个五分位数和最贫困组之间没有统计学上的显着差异。在对医院类型进行额外调整后，这些关联仍然存在，并且物质匮乏和医院类型之间不存在交互作用（p交互作用> 0.1）。

我们观察到，尽管享有全民医疗保健，但不同社会经济地位在使用溶栓或血栓切除术治疗急性缺血性卒中方面存在差异。需要有针对性的医疗保健政策、公共卫生信息和资源分配，以确保所有患者都能公平地获得急性中风治疗。