Audrey C Leasure1, Zachary A King1, Victor Torres-Lopez1, Santosh B Murthy1, Hooman Kamel1, Ashkan Shoamanesh1, Rustam Al-Shahi Salman1, Jonathan Rosand1, Wendy C Ziai1, Daniel F Hanley1, Daniel Woo1, Charles C Matouk1, Lauren H Sansing1, Guido J Falcone1, Kevin N Sheth2. 1. From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH. 2. From the Departments of Neurology (A.C.L., Z.A.K., V.T.-L., L.H.S., G.J.F., K.N.S.) and Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, CT; Department of Neurology (S.B.M., H.K.), Weill Cornell Medicine, New York, NY; Department of Neurology (A.S.), McMaster University, Population Health Research Institute, Hamilton, Canada; Centre for Clinical Brain Sciences (R.A.-S.S.), University of Edinburgh, UK; Division of Neurocritical Care and Emergency Neurology and Henry and Allison McCance Center for Brain Health (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (W.C.Z., D.F.H.), Johns Hopkins University, Baltimore, MD; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH. kevin.sheth@yale.edu.
Abstract
OBJECTIVE: To estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk. METHODS: We performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders. RESULTS: We identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%-3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01-1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10-1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50-0.73; p < 0.001), with consistent estimates across racial/ethnic groups. CONCLUSIONS: Black and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.
OBJECTIVE: To estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk. METHODS: We performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders. RESULTS: We identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%-3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01-1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10-1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50-0.73; p < 0.001), with consistent estimates across racial/ethnic groups. CONCLUSIONS: Black and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.
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