Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage

Xian, Ying; Holloway, Robert G.; Smith, Eric E.; Schwamm, Lee H.; Reeves, Mathew J.; Bhatt, Deepak L.; Schulte, Phillip J.; Cox, Margueritte; Olson, DaiWai M.; Hernandez, Adrian F.; Lytle, Barbara L.; Anstrom, Kevin J.; Fonarow, Gregg C.; Peterson, Eric D.

doi:10.1161/strokeaha.114.005620

Cited by 40 publications

(50 citation statements)

References 39 publications

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“…Impaired CSF flow and resultant hydrocephalus is one of the most important mechanisms by which IVH may contribute to morbidity and mortality in ICH. Blacks with ICH/IVH presented at a younger age in our study and in others 3, 6, 7. Similarly, hydrocephalus after ICH with IVH occurs more commonly in younger patients 24.…”

Section: Discussionsupporting

confidence: 64%

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Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Faigle

Marsh

Llinás

et al. 2016

JAHA

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BackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients.Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race.Conclusions IVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.

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Section: Discussionsupporting

confidence: 64%

“…ICH incidence rates are especially high among black patients compared to whites 3, 4, 5. In addition, blacks with ICH present at an earlier age than their white counterparts 6, 7…”

Section: Introductionmentioning

confidence: 99%

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Faigle

Marsh

Llinás

et al. 2016

JAHA

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“…Interestingly, the reported mortality rates in these studies vary substantially depending on the originating country, with rather low short-term mortality in Asian countries [16,17] and markedly higher mortality rates up to 70% in studies originating from European countries [7] and the United States [18] . Two possible factors may account for this finding: first, although the incidence of ICH is known to be higher in Asians than in Caucasians, a recent study on racial/ethnic differences in the outcome of ICH patients found lower risk-adjusted, in-hospital mortality for Asian than white patients with ICH [19] . Second, ICU admission criteria in Asian countries may vary considerably from those in Europe/United States, not at least because of the limited access to tertiary care centers in many Asian countries [20] .…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Alonso¹,

Ebert²,

Kern³

et al. 2015

Cerebrovasc Dis

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Background: The prognosis of stroke patients admitted to intensive care units (ICU) is commonly regarded to be poor. However, only limited data regarding outcome predictors are available. Patients and Methods: Out of 4,958 consecutive patients admitted to our stroke unit with the diagnosis of acute stroke, after analysis we identified 347 patients (164 male) in need of ICU management. In-hospital and post-rehabilitation mortality as well as functional outcome at discharge and after rehabilitation were analyzed. Results: Ischemic stroke was diagnosed in 252 patients (72.6%) and intracerebral hemorrhage occurred in 95 patients (27.4%). The mean age in our cohort was considerably high (70.8 years). One hundred patients were comatose at admission. The median NIHSS score at admission in the remaining patients was 12. Apart from stroke-related disturbances of consciousness (47.1%), the most common reasons for ICU treatment were cardiac (23.4%) and respiratory (12.1%) complications or interventional procedures requiring mechanical ventilation (11%). In all, 231/347 patients (66.6%) were mechanically ventilated (mean 84 h). In-hospital mortality (143/347; 41.2%) was associated with old age, poor NIHSS score at admission, intracerebral hemorrhage and mechanical ventilation (p < 0.001 in all). Further, admission to ICU because of stroke-related impairment of consciousness increased in-hospital mortality (p < 0.001). Similarly, poor outcome after rehabilitation was associated with old age (p = 0.029) and mechanical ventilation (p < 0.001). In patients ≥80 years with either intracerebral hemorrhage or need of mechanical ventilation, outcome was unfavorable in nearly any case. However, the overall post-rehabilitation outcome did not differ between patients with intracerebral hemorrhage and ischemic stroke (p = 0.275). Conclusion: The stroke population in our study was associated with an increased early mortality; however, given the same conditions, it was old with a high percentage of patients requiring mechanical ventilation. This did not result in increased in-hospital mortality rates compared to younger and less severely affected cohorts. Thus, ICU management is a life-saving initiative even among the elderly. However, the functional outcome was poor in older patients, thus limiting the benefits of ICU care in these patients.

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“…Despite disparities in care, this relationship has also been identified in other conditions including stroke. 36 The reasons for differences in outcome according to race/ethnicity are varied and include factors at the hospital-level (e.g., quality of care) and patient-level (e.g., preferences of care). Our findings are also concordant with prior studies, which suggest that an individual's health is related to the environment in which he or she lives.…”

Section: Discussionmentioning

confidence: 99%

Utility of Socioeconomic Status in Predicting 30-Day Outcomes After Heart Failure Hospitalization

Eapen

McCoy

Fonarow

et al. 2015

Circ: Heart Failure

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Background An individual's socioeconomic status (SES) is associated with health outcomes and mortality, yet it is unknown whether accounting for SES can improve risk-adjustment models for 30-day outcomes among Centers for Medicare & Medicaid Services (CMS) beneficiaries hospitalized with heart failure (HF). Methods and Results We linked clinical data on hospitalized HF patients in the Get With The Guidelines®-HF™ database (01/2005–12/2011) with CMS claims and county-level SES data from the 2012 Area Health Resources Files. We compared the discriminatory capabilities of multivariable models that adjusted for SES, patient, and/or hospital characteristics to determine whether county-level SES data improved prediction or changed hospital rankings for 30-day all-cause mortality and rehospitalization. After adjusting for patient and hospital characteristics, median household income (per $5,000 increase) was inversely associated with odds of 30-day mortality (OR 0.97, 95% CI 0.95–1.00, p=0.032), and the percentage of persons with at least a high school diploma (per 5 unit increase) was associated with lower odds of 30-day rehospitalization (OR 0.95, 95% CI 0.91–0.99).After adjustment for county-level SES data, relative to whites, Hispanic ethnicity (OR 0.70, 95% CI 0.58, 0.83) and black race (OR 0.57, 95% CI: 0.50–0.65) remained significantly associated with lower 30-day mortality, but had similar 30-day rehospitalization. County-level SES did not improve risk adjustment or change hospital rankings for 30-day mortality or rehospitalization. Conclusions County-level SES data are modestly associated with 30-day outcomes for CMS beneficiaries hospitalized with HF, but do not improve risk adjustment models based on patient characteristics alone.

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Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage

Cited by 40 publications

References 39 publications

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Utility of Socioeconomic Status in Predicting 30-Day Outcomes After Heart Failure Hospitalization

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