Racial/ethnic differences in outcomes following subarachnoid hemorrhage

University of Toronto researchers examined data on patients who had been hospitalized in the United States for subarachnoid hemorrhage (SAH) and found racial/ethnic differences in the rates of inpatient mortality and hospital discharge to institutional care. Compared to white patients, Asian/Pacific Islander patients were more likely and Hispanic patients less likely to die while in the hospital. African-American patients were more likely than white patients to require institutional care following discharge from the hospital, although their risk of death while in the hospital was similar to that of white patients. The likelihood of needing post-hospitalization institutional care was similar among white, Hispanic, Asian/Pacific Islander, and Native American patients. Detailed findings on these racial disparities are reported and discussed in "Racial/ethnic differences in inpatient mortality and use of institutional postacute care following subarachnoid hemorrhage. Clinical article," by Blessing N. R. Jaja, M.B.B.S., M.Sc., Gustavo Saposnik, M.D., M.Sc., F.R.C.P.C., Rosane Nisenbaum, Ph.D., Benjamin W. Y. Lo, M.D., M.Sc., F.R.C.S.C., Tom A. Schweizer, Ph.D. Kevin E. Thorpe, M.Math., and R. Loch Macdonald, M.D., Ph.D., F.R.C.S., published today online, ahead of print, in the Journal of Neurosurgery.

Subarachnoid hemorrhage (SAH) - that is, bleeding into the subarachnoid space that surrounds the brain—can increase pressure in the skull, damage or kill brain cells, and deprive the brain of oxygen. Many victims of SAH do not survive long enough to obtain treatment; those who do may die while undergoing treatment in the hospital, make a complete recovery, or survive with transient or permanent brain defects.

Jaja and colleagues set out to examine whether race or ethnicity had a bearing on who was most likely to die while in the hospital following an SAH and who was most likely to be discharged from the hospital to another post-acute institutional setting for further care. To do so, these researchers performed a cross-sectional study of hospital discharges for patients whose primary diagnosis was SAH unrelated to trauma. They examined data from the Nationwide Inpatient Sample, a large all-payer hospital care database. Focusing on the years 2005 through 2010, the researchers identified 31,631 hospital discharges related to stays for SAH.

In this study, inpatient mortality was the primary outcome and discharge to institutional care was the secondary outcome. In the statistical analyses, the independent variable was patient-identified race/ethnicity: white, black, Hispanic, Asian/Pacific Islander, or Native American. The researchers took into account explanatory or confounding variables in the relationships of race/ethnicity to the primary and secondary outcomes, specifically comorbid conditions as well as demographic, clinical, and hospital-related factors.

Among patients admitted to the hospital for SAH, Jaja and colleagues found a crude inpatient mortality rate of 22% and a 42% rate of hospital discharge to institutional care. Multivariable analyses identified race/ethnicity as a significant predictor of both inpatient mortality (p = 0.003) and discharge to institutional care (p ≤ 0001). In their analyses of the impact of race/ethnicity on the primary and secondary outcomes, the researchers found the following: