Potential crowdedness of mechanical thrombectomy and cerebral infarction mortality in Japan: Application of inverted two-step floating catchment area method

Objectives: This study aimed to evaluate a stroke medical delivery system based on population coverage and the potential crowdedness index (PCI) of mechanical thrombectomy and investigate the relationship between PCI and cerebral infarction mortality in Japan. Materials and methods: This cross-sectional study defined 662 facilities and 1605 neurointerventionalists as supply, population aged 55 years or older as demand, and set the reachable area for demand as 120 min in driving time. Multiple regression analysis adjusted for spatial autocorrelation was used to exam-ine the relationship between PCI and cerebral infarction mortality. Results: In the 2020 data, 99% of the population aged 55 years or older had access to mechanical thrombectomy (<= 120 min), and the PCI ranged from 5876 to 129838, with a median of 30426. From 2020 to 2035, the PCI is estimated to increase (30426 to 32510), decreasing after 2035 (32510 to 29469). The PCI distribution exhibited geographical heterogeneity. High PCI values emerged in eastern Japan. According to regression analysis, the increase in PCI by 1% led to an increase of 0.13% in standardized mor-tality ratio of cerebral infarction in men. However, PCI did not significantly corre-late with cerebral infarction mortality in women. Conclusions: PCI for hospitals based on supply and demand was geographically heterogeneous in Japan. Optimi-zation of PCI contributes equalization of mechanical thrombectomy provision sys-tem and may improve cerebral infarction mortality.(c) 2022 Elsevier Inc. All rights reserved.