Rumalla Kavelin, Catapano Joshua S, Mahadevan Varun, Sorkhi Samuel R, Koester Stefan W, Winkler Ethan A, Graffeo Christopher S, Srinivasan Visish M, Jha Ruchira M, Jadhav Ashutosh P, Ducruet Andrew F, Albuquerque Felipe C, Lawton Michael T
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2023 May;173:e109-e120. doi: 10.1016/j.wneu.2023.02.018. Epub 2023 Feb 11.
Sparse data exist on socioeconomic disparities among patients treated for aneurysmal subarachnoid hemorrhage (aSAH). The authors analyzed factors possibly influencing patient outcomes, including having a primary care physician (PCP) at admission, family/caregiver support, a foreign language barrier, primary payer status, and race.
Socioeconomic data were abstracted for patients treated endovascularly or microsurgically for aSAH at a single center (January 1, 2014-July 31, 2019). Binary logistic regression analyses were used to identify independent predictors of an unfavorable outcome (modified Rankin Scale [mRS] score >2) and for predictive modeling.
Among 422 patients, the median (interquartile range) follow-up was 2 (1-23) months. Lack of caregiver support was the only socioeconomic factor associated with an unfavorable outcome at discharge. Independent predictors of mRS score >2 at last follow-up included baseline markers of disease severity (P ≤ 0.03), nonwhite race (OR, 1.69; P = 0.047), lack of caregiver support (OR, 5.55; P = 0.007), and lack of a PCP (OR, 1.96; P = 0.007). Adjusting for follow-up mediated the effects of race and PCP, although caregiver support remained significant and PCP was associated with a lower mortality risk independent of follow-up (OR, 0.51; P = 0.047). Predischarge socioeconomic factors, alongside disease severity, predicted a follow-up mRS score >2 with excellent discrimination (area under the receiver operating curve, 0.81; 95% CI, 0.77-0.86).
At a large, urban, comprehensive stroke center, patients with PCPs, caregiver support, and white race had significantly better long-term outcomes after aSAH. These results reflect disparities in access to healthcare after aSAH for vulnerable populations with extensive lifetime needs.
关于接受动脉瘤性蛛网膜下腔出血（aSAH）治疗的患者的社会经济差异的数据稀少。作者分析了可能影响患者预后的因素，包括入院时是否有初级保健医生（PCP）、家庭/照顾者支持、外语障碍、主要支付者状态和种族。
提取了在单一中心（2014年1月1日至2019年7月31日）接受aSAH血管内或显微手术治疗的患者的社会经济数据。采用二元逻辑回归分析来确定不良预后（改良Rankin量表[mRS]评分>2）的独立预测因素并进行预测建模。
在422例患者中，中位（四分位间距）随访时间为2（1 - 23）个月。缺乏照顾者支持是与出院时不良预后相关的唯一社会经济因素。最后随访时mRS评分>2的独立预测因素包括疾病严重程度的基线指标（P≤0.03）、非白人种族（OR，1.69；P = 0.047）、缺乏照顾者支持（OR，5.55；P = 0.007）和缺乏PCP（OR，1.96；P = 0.007）。对随访进行调整后，种族和PCP的影响得到了调节，尽管照顾者支持仍然显著，且PCP与独立于随访的较低死亡风险相关（OR，0.51；P = 0.047）。出院前的社会经济因素与疾病严重程度一起，对随访时mRS评分>2具有出色的辨别能力（受试者操作特征曲线下面积，0.81；95%CI，0.77 - 0.86）。
在一个大型的城市综合卒中中心，有PCP、照顾者支持且为白人种族的患者在aSAH后长期预后明显更好。这些结果反映了aSAH后弱势群体在获得医疗保健方面的差异，这些群体有广泛的终身需求。
