Schupper Alexander J, Hardigan Trevor A, Mehta Amol, Yim Benjamin, Yaeger Kurt A, De Leacy Reade, Fifi Johanna T, Mocco J, Majidi Shahram
Icahn School of Medicine at Mount Sinai, New York, NY (A.J.S., T.A.H., R.D.L., J.T.F.).
Department of Neurology, Columbia University Irving Medical Center, New York, NY (A.M.).
Stroke. 2023 May;54(5):1347-1356. doi: 10.1161/STROKEAHA.122.041488. Epub 2023 Apr 24.
Aneurysmal subarachnoid hemorrhage is associated with high rate of morbidity and mortality. We aimed to assess prognostic impact of sex, race, and ethnicity in these patients.
Nationwide Inpatient Sample (2000-2019) was used to identify patients presenting with aneurysmal subarachnoid hemorrhage as primary diagnosis. Patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities, type of the hospital, and treatment modality used for aneurysm repair were extracted. The previously validated Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale was used to estimate the clinical severity. Discharge destination and in-hospital mortality was used as outcome measured. The impact of race/ethnicity and sex on clinical outcome was analyzed using multivariate regression models.
A total of 161 086 patients with aneurysmal subarachnoid hemorrhage were identified. Mean age was 55.0±13.8 years. Sixty-nine percent of the patients were female, 60% White patients, and 17% Black patients. There was no difference in the Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Scale score between the 2 sexes. Women had significantly lower odds of good clinical outcome (defined as discharge to home or acute rehabilitation facility; RR, 0.83 [95% CI, 0.74-0.94]; =0.004). Hispanic patients (RR, 1.12 [95% CI, 1.07-1.17]; <0.001) had higher odds of excellent clinical outcome compared with White patients, and lower risk of mortality were observed in Black patients (RR, 0.73 [95% CI, 0.66-0.81]) and Hispanic patients (RR, 0.78 [95% CI, 0.70-0.86]) compared with the White patients.
In this nationally representative study, women were less likely to have excellent outcomes following aneurysmal subarachnoid hemorrhage, and White patients had disproportionately higher likelihood of worse clinical outcomes. Lower rates of mortality were seen among Black and Hispanic patients.
动脉瘤性蛛网膜下腔出血与高发病率和死亡率相关。我们旨在评估性别、种族和族裔对这些患者预后的影响。
使用全国住院患者样本（2000 - 2019年）来识别以动脉瘤性蛛网膜下腔出血为主要诊断的患者。提取患者的年龄、性别、种族/族裔、保险状况、社会经济地位、合并症、医院类型以及用于动脉瘤修复的治疗方式。使用先前验证的全国住院患者样本蛛网膜下腔出血严重程度量表来评估临床严重程度。将出院去向和住院死亡率作为结局指标。使用多变量回归模型分析种族/族裔和性别对临床结局的影响。
共识别出161086例动脉瘤性蛛网膜下腔出血患者。平均年龄为55.0±13.8岁。69%的患者为女性，60%为白人患者，17%为黑人患者。两性之间的全国住院患者样本蛛网膜下腔出血严重程度量表评分无差异。女性获得良好临床结局（定义为出院回家或进入急性康复机构；RR，0.83 [95%CI，0.74 - 0.94]；P = 0.004）的几率显著较低。与白人患者相比，西班牙裔患者获得极佳临床结局的几率更高（RR，1.12 [95%CI，1.07 - 1.17]；P < 0.001），并且观察到黑人患者（RR，0.73 [95%CI，0.66 - 0.81]）和西班牙裔患者（RR，0.78 [95%CI，0.70 - 0.86]）的死亡风险低于白人患者。
在这项具有全国代表性的研究中，动脉瘤性蛛网膜下腔出血后女性获得极佳结局的可能性较小，白人患者出现较差临床结局的可能性过高。黑人和西班牙裔患者的死亡率较低。
