Mayerhofer Ernst, Zaba Natalie O, Parodi Livia, Ganbold Alena S, Biffi Alessandro, Rosand Jonathan, Yechoor Nirupama, Anderson Christopher D
Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States.
Front Neurol. 2023 Jun 8;14:1194810. doi: 10.3389/fneur.2023.1194810. eCollection 2023.
Intracerebral hemorrhage (ICH) disproportionally affects underserved populations, and coincides with risk factors for cardiovascular events and cognitive decline after ICH. We investigated associations between social determinants of health and management of blood pressure (BP), hyperlipidemia, diabetes, obstructive sleep apnea (OSA), and hearing impairment before and after ICH hospitalization.
Survivors of the Massachusetts General Hospital longitudinal ICH study between 2016 and 2019 who received healthcare at least 6 months after ICH were analyzed. Measurements of BP, LDL and HbA1c and their management in the year surrounding ICH and referrals for sleep studies and audiology up to 6 months after ICH were gathered from electronic health records. The US-wide area deprivation index (ADI) was used as proxy for social determinants of health.
The study included 234 patients (mean 71 years, 42% female). BP measurements were performed in 109 (47%) before ICH, LDL measurements were performed in 165 (71%), and HbA1c measurements in 154 (66%) patients before or after ICH. 27/59 (46%) with off-target LDL and 3/12 (25%) with off-target HbA1c were managed appropriately. Of those without history of OSA or hearing impairment before ICH, 47/207 (23%) were referred for sleep studies and 16/212 (8%) to audiology. Higher ADI was associated with lower odds of BP, LDL, and HbA1c measurement prior to ICH [OR 0.94 (0.90-0.99), 0.96 (0.93-0.99), and 0.96 (0.93-0.99), respectively, per decile] but not with management during or after hospitalization.
Social determinants of health are associated with pre-ICH management of cerebrovascular risk factors. More than 25% of patients were not assessed for hyperlipidemia and diabetes in the year surrounding ICH hospitalization, and less than half of those with off-target values received treatment intensification. Few patients were evaluated for OSA and hearing impairment, both common among ICH survivors. Future trials should evaluate whether using the ICH hospitalization to systematically address co-morbidities can improve long-term outcomes.
脑出血（ICH）对医疗服务不足的人群影响尤为严重，且与脑出血后心血管事件和认知功能下降的风险因素同时存在。我们调查了健康的社会决定因素与脑出血住院前后血压（BP）、高脂血症、糖尿病、阻塞性睡眠呼吸暂停（OSA）和听力障碍管理之间的关联。
对2016年至2019年期间在马萨诸塞州总医院进行纵向脑出血研究的幸存者进行分析，这些幸存者在脑出血后至少接受了6个月的医疗保健。从电子健康记录中收集脑出血前后一年的血压、低密度脂蛋白（LDL）和糖化血红蛋白（HbA1c）测量值及其管理情况，以及脑出血后长达6个月的睡眠研究和听力检查转诊情况。使用美国全区域贫困指数（ADI）作为健康的社会决定因素的代理指标。
该研究纳入了234例患者（平均年龄71岁，42%为女性）。脑出血前109例（47%）进行了血压测量，165例（71%）进行了LDL测量，154例（66%）患者在脑出血前后进行了HbA1c测量。27/59例（46%）LDL未达标的患者和3/12例（25%）HbA1c未达标的患者得到了适当管理。在脑出血前无OSA或听力障碍病史的患者中，47/207例（23%）被转诊进行睡眠研究，16/212例（8%）被转诊进行听力检查。较高的ADI与脑出血前血压、LDL和HbA1c测量几率较低相关[每十分位数的比值比（OR）分别为0.94（0.90 - 0.99）、0.96（0.93 - 0.99）和0.96（0.93 - 0.99）]，但与住院期间或之后的管理无关。
健康的社会决定因素与脑出血前脑血管危险因素的管理相关。在脑出血住院前后一年中，超过25%的患者未接受高脂血症和糖尿病评估，未达标的患者中不到一半接受了强化治疗。很少有患者接受OSA和听力障碍评估，而这在脑出血幸存者中很常见。未来的试验应评估利用脑出血住院来系统解决合并症是否能改善长期预后。
