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

BACKGROUND: Sparse data exist on socioeconomic disparities among patients treated for aneurysmal sub-arachnoid hemorrhage (aSAH). The authors analyzed fac-tors 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. METHODS: 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 (modi-fied Rankin Scale [mRS] score >2) and for predictive modeling. RESULTS: 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 pound 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 indepen-dent of follow-up (OR, 0.51; P = 0.047). Predischarge so-cioeconomic 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). CONCLUSIONS: 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.

Automated summary

This study analyzed factors that may influence patient outcomes after aneurysmal sub-arachnoid hemorrhage (aSAH), including having a primary care physician, family/caregiver support, language barrier, primary payer status, and race. It found that patients with a PCP, caregiver support, and white race had better long-term outcomes after aSAH.