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Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global...
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Published in: | World neurosurgery 2024-07, Vol.187, p.202-210.e4 |
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creator | Lim, Jaims Aguirre, Alexander O. Baig, Ammad A. Levy, Bennett R. Ladner, Liliana R. Crider, Corianne Garay-Morales, Steven Yu Alfonzo, Sabrina Galloza, Daniel Jaikumar, Vinay Monteiro, Andre Kuo, Cathleen C. Vakharia, Kunal Lai, Pui Man Rosalind Snyder, Kenneth V. Davies, Jason M. Siddiqui, Adnan H. Levy, Elad I. |
description | Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global disparities in aSAH presentation and management.
PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported.
After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC.
In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide. |
doi_str_mv | 10.1016/j.wneu.2024.05.032 |
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PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported.
After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC.
In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.]]></description><identifier>ISSN: 1878-8750</identifier><identifier>ISSN: 1878-8769</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2024.05.032</identifier><identifier>PMID: 38750883</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Disparity ; Embolization, Therapeutic ; Endovascular Procedures ; Global ; Global Health ; Healthcare Disparities ; Humans ; Intracranial Aneurysm - epidemiology ; Intracranial Aneurysm - therapy ; Neurosurgical Procedures ; Prevalence ; Review ; Subarachnoid hemorrhage ; Subarachnoid Hemorrhage - epidemiology ; Subarachnoid Hemorrhage - therapy</subject><ispartof>World neurosurgery, 2024-07, Vol.187, p.202-210.e4</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-ab0968db95035d989443534efeaa23cdfc157e2144529d82b053fb29fddc63853</cites><orcidid>0000-0002-3971-8963 ; 0000-0002-0534-7906 ; 0000-0002-6677-1858 ; 0000-0001-9914-3404 ; 0009-0008-0486-0880 ; 0000-0001-8222-8874 ; 0000-0002-8969-3805 ; 0000-0002-6208-3724 ; 0000-0002-9450-3113</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38750883$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, Jaims</creatorcontrib><creatorcontrib>Aguirre, Alexander O.</creatorcontrib><creatorcontrib>Baig, Ammad A.</creatorcontrib><creatorcontrib>Levy, Bennett R.</creatorcontrib><creatorcontrib>Ladner, Liliana R.</creatorcontrib><creatorcontrib>Crider, Corianne</creatorcontrib><creatorcontrib>Garay-Morales, Steven</creatorcontrib><creatorcontrib>Yu Alfonzo, Sabrina</creatorcontrib><creatorcontrib>Galloza, Daniel</creatorcontrib><creatorcontrib>Jaikumar, Vinay</creatorcontrib><creatorcontrib>Monteiro, Andre</creatorcontrib><creatorcontrib>Kuo, Cathleen C.</creatorcontrib><creatorcontrib>Vakharia, Kunal</creatorcontrib><creatorcontrib>Lai, Pui Man Rosalind</creatorcontrib><creatorcontrib>Snyder, Kenneth V.</creatorcontrib><creatorcontrib>Davies, Jason M.</creatorcontrib><creatorcontrib>Siddiqui, Adnan H.</creatorcontrib><creatorcontrib>Levy, Elad I.</creatorcontrib><title>Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description><![CDATA[Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global disparities in aSAH presentation and management.
PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported.
After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC.
In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.]]></description><subject>Disparity</subject><subject>Embolization, Therapeutic</subject><subject>Endovascular Procedures</subject><subject>Global</subject><subject>Global Health</subject><subject>Healthcare Disparities</subject><subject>Humans</subject><subject>Intracranial Aneurysm - epidemiology</subject><subject>Intracranial Aneurysm - therapy</subject><subject>Neurosurgical Procedures</subject><subject>Prevalence</subject><subject>Review</subject><subject>Subarachnoid hemorrhage</subject><subject>Subarachnoid Hemorrhage - epidemiology</subject><subject>Subarachnoid Hemorrhage - therapy</subject><issn>1878-8750</issn><issn>1878-8769</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kM1OGzEUhS1UVKLAC3SBvGSTqX_GGU_FJgotIIFA_Kwtj32ncTRjp_ZMo7x9nQZY4o2tq--cK38IfaOkoITOv6-LrYexYISVBREF4ewITais5ExW8_rLx1uQE3SW0prkw2kpK_4VnfD9XEo-QfG6C43u8JVLGx3d4CBh5_GwAvwYIYEf9OCCx9pbfK-9_g19nuHQ4kVeH3epz-HnsdFRm5UPzuIb6EOMq0z-wAv8BH8dbP_HF153u-TSKTpudZfg7O2eotdfP1-WN7O7h-vb5eJuZhivhpluSD2XtqkF4cLWsi5LLngJLWjNuLGtoaICRstSsNpK1hDB24bVrbVmzqXgU3Rx6N3E8GeENKjeJQNdpz2EMSlOhJA1Y5RllB1QE0NKEVq1ia7XcacoUXvdaq32utVetyJCZd05dP7WPzY92I_Iu9wMXB4AyL_MGqJKxoE3YF0EMygb3Gf9_wDXuJG5</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Lim, Jaims</creator><creator>Aguirre, Alexander O.</creator><creator>Baig, Ammad A.</creator><creator>Levy, Bennett R.</creator><creator>Ladner, Liliana R.</creator><creator>Crider, Corianne</creator><creator>Garay-Morales, Steven</creator><creator>Yu Alfonzo, Sabrina</creator><creator>Galloza, Daniel</creator><creator>Jaikumar, Vinay</creator><creator>Monteiro, Andre</creator><creator>Kuo, Cathleen C.</creator><creator>Vakharia, Kunal</creator><creator>Lai, Pui Man Rosalind</creator><creator>Snyder, Kenneth V.</creator><creator>Davies, Jason M.</creator><creator>Siddiqui, Adnan H.</creator><creator>Levy, Elad I.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3971-8963</orcidid><orcidid>https://orcid.org/0000-0002-0534-7906</orcidid><orcidid>https://orcid.org/0000-0002-6677-1858</orcidid><orcidid>https://orcid.org/0000-0001-9914-3404</orcidid><orcidid>https://orcid.org/0009-0008-0486-0880</orcidid><orcidid>https://orcid.org/0000-0001-8222-8874</orcidid><orcidid>https://orcid.org/0000-0002-8969-3805</orcidid><orcidid>https://orcid.org/0000-0002-6208-3724</orcidid><orcidid>https://orcid.org/0000-0002-9450-3113</orcidid></search><sort><creationdate>202407</creationdate><title>Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis</title><author>Lim, Jaims ; 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There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global disparities in aSAH presentation and management.
PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported.
After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC.
In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38750883</pmid><doi>10.1016/j.wneu.2024.05.032</doi><orcidid>https://orcid.org/0000-0002-3971-8963</orcidid><orcidid>https://orcid.org/0000-0002-0534-7906</orcidid><orcidid>https://orcid.org/0000-0002-6677-1858</orcidid><orcidid>https://orcid.org/0000-0001-9914-3404</orcidid><orcidid>https://orcid.org/0009-0008-0486-0880</orcidid><orcidid>https://orcid.org/0000-0001-8222-8874</orcidid><orcidid>https://orcid.org/0000-0002-8969-3805</orcidid><orcidid>https://orcid.org/0000-0002-6208-3724</orcidid><orcidid>https://orcid.org/0000-0002-9450-3113</orcidid></addata></record> |
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subjects | Disparity Embolization, Therapeutic Endovascular Procedures Global Global Health Healthcare Disparities Humans Intracranial Aneurysm - epidemiology Intracranial Aneurysm - therapy Neurosurgical Procedures Prevalence Review Subarachnoid hemorrhage Subarachnoid Hemorrhage - epidemiology Subarachnoid Hemorrhage - therapy |
title | Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis |
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