Impact of primary care provider access on presenting with aneurysm Rupture: A retrospective analysis

Early treatment of unruptured intracranial aneurysms (IAs) is crucial to minimizing risk of rupture. Previous literature has identified disparities in access to care for neurological conditions based on socioeconomic status (SES). Our study evaluates trends in presentation and management of IAs based on SES.

This was a retrospective study of patients who presented for their initial encounter of IA management at a single institution between January 2018-January 2024. Area deprivation index (ADI) was used to categorize patients into five quintiles based on their residential address. Predictor variables of interest were race/ ethnicity, insurance status, marital status, primary care utilization and the use of interpreter services. Outcomes of interest were rupture at presentation, treatment and functional outcome at discharge.

688 patients presented with an aneurysm. 131 patients had ruptured aneurysms and 557 patients had unruptured aneurysms. In total, 439 patients underwent treatment. White race (OR: 0.11; 95 % CI: 0.01, 0.70, p = 0.02), ADI quintile 3 (OR: 0.41, 95 % CI: 0.20, 0.81, p = 0.01), PCP utilization (OR: 0.34, 95 % CI: 0.14, 0.86, p = 0.02) and requirement of interpreter services (OR: 0.16, 95 % CI: 0.06, 0.72, p = 0.03) were associated with decreased odds of presenting with a ruptured aneurysm. Male gender (OR: 0.57, 95 % CI: 0.35, 0.92, p = 0.02), ruptured aneruysms (OR: 33.23, 95 % CI: 10.13--108.96, p < 0.001) and aneurysm location were significantly associated with undergoing treatment of an intracranial aneurysm. Insurance status, ruptured aneurysms (OR: 9.76, 95 % CI: 4.04--25.19, p < 0.001) and aneurysm location was associated with higher odds of functional dependence on discharge.

Despite racial and socioeconomic disparities, our study identified that having a PCP was an independent predictor of decreased odds of presenting with a ruptured aneurysm. This indicates the importance of early detection of intracranial aneurysms in patients who receive care through PCPs.