Renedo Daniela, Rivier Cyprien A, Koo Andrew, Clocchiatti-Tuozzo Santiago, Huo Shufan, Sujijantarat Nanthiya, Torres-Lopez Victor M, Hebert Ryan M, Schwamm Lee, de Havenon Adam, Gunel Murat, Matouk Charles C, Falcone Guido J, Sheth Kevin N
Department of Neurology Yale School of Medicine New Haven CT USA.
Department of Neurosurgery Yale School of Medicine New Haven CT USA.
J Am Heart Assoc. 2025 Apr 15;14(8):e037199. doi: 10.1161/JAHA.124.037199. Epub 2025 Apr 7.
Nontraumatic subarachnoid hemorrhage (SAH) presents a significant health burden, yet the influence of social determinants of health on outcomes remains unclear. This study examines the impact of social determinants of health on outcomes of patients with SAH.
We conducted a retrospective analysis of prospectively collected data from the GWTG (Get With The Guidelines)-Stroke registry, including patients with SAH across the United States from 2012 to 2021. The role of the Social Deprivation Index (SDI) and adjusted gross income, stratified into tertiles, were assessed. Outcomes included in-hospital death, length of stay, and discharge disposition (good: home/rehabilitation; poor: long-term facility/hospice/death). Covariates included demographics, medical history, vascular risk factors, and SAH severity. Multivariable regressions were used to estimate associations, presenting odds ratios (ORs) and relative risks. Our study comprised 108 090 patients with nontraumatic SAH (mean age, 59.76 years; 61.3% women). The average length of stay was 12.04 days, 55.6% had good discharge disposition, and the overall mortality rate was 15.5%. Analyses showed that a high Social Deprivation Index was associated with reduced odds of a good discharge (unadjusted OR, 0.90 [95% CI, 0.87-0.92]; adjusted OR, 0.87 [95% CI, 0.82-0.92]), while higher adjusted gross income correlated with decreased death (unadjusted OR, 0.94 [95% CI, 0.90-0.97]; adjusted OR, 0.90 [95% CI, 0.83-0.96]). A high Social Deprivation Index was significantly associated with longer length of stay (unadjusted relative risk, 1.06 [95% CI, 1.07-1.26]; adjusted relative risk, 1.03 [95% CI, 1.01-1.13]).
Social determinants of health shape outcomes for patients with SAH, with a clear gradient of impact across socioeconomic levels.
非创伤性蛛网膜下腔出血（SAH）带来了重大的健康负担，但健康的社会决定因素对其预后的影响仍不明确。本研究探讨健康的社会决定因素对SAH患者预后的影响。
我们对从“遵循指南-卒中”（GWTG-Stroke）注册中心前瞻性收集的数据进行了回顾性分析，纳入了2012年至2021年美国各地的SAH患者。评估了社会剥夺指数（SDI）和调整后总收入（按三分位数分层）的作用。结局指标包括住院死亡、住院时间和出院转归（良好：回家/康复；不佳：长期护理机构/临终关怀/死亡）。协变量包括人口统计学特征、病史、血管危险因素和SAH严重程度。采用多变量回归来估计关联，呈现优势比（OR）和相对风险。我们的研究纳入了108090例非创伤性SAH患者（平均年龄59.76岁；61.3%为女性）。平均住院时间为12.04天，55.6%的患者出院转归良好，总体死亡率为15.5%。分析表明，高社会剥夺指数与良好出院几率降低相关（未调整OR，0.90[95%CI，0.87-0.92]；调整后OR，0.87[95%CI，0.82-0.92]），而较高的调整后总收入与死亡风险降低相关（未调整OR，0.94[95%CI，0.90-0.97]；调整后OR，0.90[95%CI，0.83-0.96]）。高社会剥夺指数与更长的住院时间显著相关（未调整相对风险，1.06[95%CI，1.07-1.26]；调整后相对风险，1.03[95%CI，1.01-1.13]）。
健康的社会决定因素塑造了SAH患者的预后，在社会经济水平上存在明显的影响梯度。
