Abou-Mrad Tatiana, Khalid Syed Ibad, Mirpuri Pranav, Charbel Fady T
Department of Neurosurgery, University of Illinois at Chicago; and.
Department of Neurology, University of Minnesota, Minneapolis.
Neurol Clin Pract. 2025 Aug;15(4):e200494. doi: 10.1212/CPJ.0000000000200494. Epub 2025 Jun 18.
Understanding the impact of social determinants of health (SDoH) on clinical outcomes in conditions such as intracerebral hemorrhage (ICH) is crucial for enhancing patient management and improving health policy. The aim of this study was to assess the impact of SDoH on the prognosis and clinical outcomes of patients with ICH.
This retrospective study used the MARINER165 national administrative database, encompassing medical and surgical claims from January 2010 to October 2022. It adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Patients with ICH were identified using International Classification of Diseases and Current Procedural Terminology codes. Propensity score matching generated 2 cohorts based on SDoH presence. Primary outcomes focused on functional status at 30 days and survival rates at 90 days and 1 year. Functional outcomes included the rates of tracheostomy and gastronomy tube placement, wheelchair dependency, mobility scores, and readmission within 30 days after ICH. Kaplan-Meier survival analysis was used to determine survival rates at 90 days and 1 year after index event. A significance level of < 0.05 was applied.
A total of 481,754 patients with ICH were included, with 240,877 individuals in each cohort after matching. Gender distribution was balanced (50.5% female), and common comorbidities included hypertension (89%), depression (47%), and diabetes mellitus (45%). The SDoH group demonstrated pronounced disparities in food security (87%), social integration (14.2%), and physical environment (8.3%). At 30 days, this group experienced worse functional outcomes with higher rates of tracheostomy (2% vs 0.9%, < 0.001) and G-tube placement (3.2% vs 1.5%, < 0.001), increased wheelchair dependency (3.2% vs 2.5%, < 0.001), and lower mobility scores (3.5 vs 2.7, < 0.001), alongside higher readmission rates (9.8% vs 6.2%, < 0.001). Despite these challenges, the SDoH cohort demonstrated better survival rates at both 90 days (78.1% vs 72.6%, < 0.001) and 1 year (62.1% vs 57.6%, < 0.001).
This study underscores significant disparities in functional outcomes and survival rates associated with SDoH among patients with ICH. It highlights the paradox where individuals with SDoH, despite facing greater health-related challenges and higher readmission rates, tend to survive longer. Integrating socioeconomic factors into patient management strategies is crucial for addressing these differences and improving overall health care outcomes.
了解健康的社会决定因素（SDoH）对脑出血（ICH）等疾病临床结局的影响，对于加强患者管理和完善卫生政策至关重要。本研究的目的是评估SDoH对ICH患者预后和临床结局的影响。
这项回顾性研究使用了MARINER165国家行政数据库，涵盖了2010年1月至2022年10月的医疗和外科索赔数据。该研究遵循了加强流行病学观察性研究报告指南。使用国际疾病分类和当前程序术语代码识别ICH患者。倾向评分匹配根据SDoH的存在情况生成了2个队列。主要结局集中在30天时的功能状态以及90天和1年时的生存率。功能结局包括气管切开术和胃造瘘管置入率、轮椅依赖率、活动评分以及ICH后30天内的再入院率。采用Kaplan-Meier生存分析来确定指数事件后90天和1年时的生存率。应用的显著性水平<0.05。
总共纳入了481,754例ICH患者，匹配后每个队列有240,877人。性别分布均衡（女性占50.5%），常见合并症包括高血压（89%）、抑郁症（47%）和糖尿病（45%）。SDoH组在食品安全（87%）、社会融合（14.2%）和物理环境（8.3%）方面表现出明显差异。在30天时，该组的功能结局较差，气管切开术发生率较高（2%对0.9%，<0.001），胃造瘘管置入率较高（3.2%对1.5%，<0.001），轮椅依赖增加（3.2%对2.5%，<0.001），活动评分较低（3.5对2.7，<0.001），同时再入院率较高（9.8%对6.2%，<0.001）。尽管存在这些挑战，SDoH队列在90天（78.1%对72.6%，<0.001）和1年（62.1%对57.6%，<0.001）时的生存率更高。
本研究强调了ICH患者中与SDoH相关的功能结局和生存率的显著差异。它突出了一个矛盾现象，即患有SDoH的个体尽管面临更大的健康相关挑战和更高的再入院率，但往往存活时间更长。将社会经济因素纳入患者管理策略对于解决这些差异和改善整体医疗保健结局至关重要。
