From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH.
Neurology. 2020 Jan 21;94(3):e314-e322. doi: 10.1212/WNL.0000000000008737. Epub 2019 Dec 12.
To estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk.
We performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders.
We identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%-3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01-1.48; = 0.04) and Asian participants (HR 1.29; 95% CI 1.10-1.50; = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50-0.73; < 0.001), with consistent estimates across racial/ethnic groups.
Black and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.
在一个大型的、多样化的美国人群中评估颅内出血（ICH）复发的风险，并确定风险较高的种族/民族和社会经济亚组。
我们对 2005 年至 2011 年期间加利福尼亚州非联邦医院所有住院患者的前瞻性收集的索赔数据进行了纵向分析。我们使用经过验证的诊断代码来识别非外伤性 ICH 和我们的主要复发 ICH 结果。存活至出院的加利福尼亚居民被纳入研究。我们使用对数秩检验进行未调整的生存分析，以比较不同种族/民族组之间的生存情况，并使用多变量 Cox 比例风险回归来确定调整潜在混杂因素后与复发风险相关的因素。
我们确定了 31355 名首次记录 ICH 且存活至出院的加利福尼亚居民，其中 15548 名（50%）为白人，6174 名（20%）为西班牙裔，4205 名（14%）为亚洲人，2772 名（9%）为黑人。中位随访 2.9 年（四分位距 3.8）期间，共有 1330 例复发（4.1%）。1 年复发率为 3.0%（95%置信区间 [CI] 2.8%-3.2%）。多变量分析显示，黑人参与者（风险比 [HR] 1.22；95%CI 1.01-1.48； = 0.04）和亚洲参与者（HR 1.29；95%CI 1.10-1.50； = 0.001）的复发风险高于白人参与者。与 Medicare 患者相比，私人保险与风险显著降低相关（HR 0.60；95%CI 0.50-0.73； < 0.001），且在不同种族/民族组中估计值一致。
与白人患者相比，黑人和亚洲患者颅内出血复发的风险更高，而与 Medicare 患者相比，私人保险与降低风险相关。需要进一步研究以确定这些差异的驱动因素。
