Socioeconomic Drivers of Outcomes After Aneurysmal Subarachnoid Hemorrhage Treatment at a Large Comprehensive Stroke Center

• Published in: World neurosurgery 2023-05, Vol.173, p.e109-e120
• Main Authors: 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.
• Format: Article
• Language: English
• Subjects: Aneurysm; Caregiver; Hospitalization; Humans; Insurance; Patient Discharge; Primary care physician; Psychosocial; Race; Retrospective Studies; Socioeconomic; Stroke; Subarachnoid Hemorrhage - therapy; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.02.018

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.