Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, 3200 University Drive, Davie, FL, 33328, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Neurocrit Care. 2022 Aug;37(1):209-218. doi: 10.1007/s12028-022-01476-5. Epub 2022 Mar 18.
Lifestyle modifications and advances in surgical and endovascular techniques for treating unruptured intracranial aneurysm (UIA) have vastly evolved over the last few decades and may have reduced the incidence of aneurysmal subarachnoid hemorrhage (aSAH). However, the actual impact of these changes on the rates and outcomes of aSAH remain unexplored. Thus, we studied national aSAH admissions and outcome trends and changes of major risk factors over time.
We queried the National Inpatient Sample between 2006 and 2018 to identify adult patients admitted and treated for UIA or ruptured aneurysm with aSAH. The Cochran-Armitage test was conducted to assess the linear trend of proportion of prevalence, inpatient mortality, hypertension, and current smoking status among aSAH admissions. Multivariable logistic regression was conducted to assess the odds of presenting with aSAH versus UIA, in addition to the odds of inpatient mortality among patients with aSAH.
A total of 159,913 patients presented with UIA and 133,567 presented with aSAH. Admissions for aSAH decreased by 0.97% (p < 0.001) per year. Current smoking and hypertension were associated with higher odds of being admitted for aSAH compared with the treatment for UIA (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.29-1.48; OR 1.15, 95% CI 1.08-1.22, respectively). Compared with White patients, Black patients (OR 1.32, 95% CI 1.21-1.43), Hispanic patients (OR 1.38, 95% CI 1.25-1.52), and patients of other races and/or ethnicities (OR 1.73, 95% CI 1.54-1.95) had a higher chance of presenting with aSAH. Rates of inpatient mortality among aSAH admissions showed no change over time (p = 0.21). Among patients admitted with aSAH, current smoking and hypertension showed an upward trend of 0.58% (p < 0.001) and 1.60% (p < 0.001) per year, respectively.
Despite a downward trend in the annual frequency of hospitalizations for aSAH, inpatient mortality rates for patients undergoing treatment of the ruptured aneurysm have remained unchanged in the United States. Smoking and hypertension are increasingly prevalent among patients with aSAH. Thus, efforts to control these modifiable risk factors must be further strengthened.
在过去的几十年中，针对未破裂颅内动脉瘤（UIA）的生活方式改变和手术及血管内技术的进步已经有了很大的发展，这可能降低了动脉瘤性蛛网膜下腔出血（aSAH）的发生率。然而，这些变化对 aSAH 的发生率和结果的实际影响仍未得到探索。因此，我们研究了全国范围内 aSAH 入院和结局趋势以及主要危险因素随时间的变化。
我们在 2006 年至 2018 年期间查询了国家住院患者样本，以确定成年患者因 UIA 或破裂性动脉瘤伴 aSAH 而入院和接受治疗的情况。我们进行 Cochran-Armitage 检验，以评估 aSAH 入院患者中流行率、住院死亡率、高血压和当前吸烟状态的比例呈线性趋势。我们进行多变量逻辑回归，以评估与 UIA 治疗相比，aSAH 入院的几率，以及 aSAH 患者的住院死亡率几率。
共有 159913 例患者因 UIA 入院，133567 例患者因 aSAH 入院。aSAH 的入院率每年下降 0.97%（p<0.001）。与治疗 UIA 相比，当前吸烟和高血压与 aSAH 入院的几率更高（比值比[OR]1.38，95%置信区间[CI]1.29-1.48；OR 1.15，95% CI 1.08-1.22）。与白人患者相比，黑人患者（OR 1.32，95% CI 1.21-1.43）、西班牙裔患者（OR 1.38，95% CI 1.25-1.52）和其他种族和/或族裔患者（OR 1.73，95% CI 1.54-1.95）发生 aSAH 的几率更高。aSAH 入院患者的住院死亡率没有随时间变化（p=0.21）。在因 aSAH 入院的患者中，当前吸烟和高血压的趋势分别为每年上升 0.58%（p<0.001）和 1.60%（p<0.001）。
尽管 aSAH 的住院频率呈下降趋势，但美国接受破裂性动脉瘤治疗的患者的住院死亡率保持不变。吸烟和高血压在 aSAH 患者中越来越普遍。因此，必须进一步加强对这些可改变的危险因素的控制。
