Abstract HUP7: Impact of Social Determinants of Health and Academic Hospital Care on Outcomes After Non-Traumatic Subarachnoid Hemorrhage

Abstract

Background: Growing evidence shows that SDOH and care setting affect ischemic stroke recovery. Impact on non-traumatic SAH is unclear. We studied SDOH and academic hospital influence on SAH outcomes. Methods: We conducted a retrospective study using data from the GWTG Stroke. All analyses were conducted using the Precision Medicine Platform. Hospitals partaking in this study obtained either human research approval for enrolment without patient consent or an IRB exemption. The exposures of interest were the Social Deprivation Index (SDI), the Adjusted Gross Income (AGI), and academic hospital care status. SDI and AGI were divided into three groups each, and care setting was labeled as academic or non-academic. Measured outcomes were: in-hospital death, length of stay (LOS), and discharge disposition (DD). We used regression with interaction terms to assess SDOH and care setting impact. Results: The study included 146,310 SAH patients (mean age 60, female sex 61%). Higher SDI was associated with longer LOS (unadjusted median days 11.1, 12.1 and 12.8) and worse DD (unadjusted risk 42.4%, 44%, 44.7%) (p < 0.001). Lower AGI was associated with increased in-hospital mortality (15.9%, 15.5%, 15.1%) and worse DD (44.2%, 43.9%, 43.1%) (p < 0.001). Academic hospital care demonstrated lower LOS (7.7±10.9 vs. 13.2±14.8, p < 0.001), reduced in-hospital mortality (13.8% vs. 16%, p < 0.001), and better DD (63.3% vs. 53.2%, p < 0.001). Adjusted multivariate analysis confirmed these findings. In comparison to the first, for the third tertile of the SDI, the odds for having a good outcome discharge were 0.87 (95% CI 0.82-0.92, p < 0.001). Additionally, SDI third tertile was associated with a significant increase in LOS (Beta 2.05; p=0.001). Higher AGI was correlated with reduced mortality (OR 0.90; 95% CI 0.83-0.96, p=0.004). Academic care was linked to lower in-hospital mortality (OR 0.89; 95% CI 0.81-0.98, p=0.029) and improved DD (OR 1.09; 95% CI 1.01-1.17, p=0.002). Interaction analysis revealed that academic care and higher AGI lead to synergistic reductions in LOS and better discharge outcomes (p<0.05). Conclusion: This analysis of GWTG-Stroke highlights the significant independent and synergistic influence of SDOH and academic hospital care on outcomes following SAH