Abstract TP455: Race-Ethnic Disparities in Subarachnoid Hemorrhage Outcomes

Abstract

Introduction: Identification of race/ethnic disparities in stroke outcomes is essential in achieving equity of patient care across demographic subgroups. We sought to identify disparities by race/ethnicity in patient outcomes following subarachnoid hemorrhage (SAH). Methods: Records obtained from the Florida Stroke Registry (FSR), a multi-hospital Get With the Guidelines (GWTG)-Stroke data collaborative, were used to compare descriptive statistics and outcomes by race/ethnicity. Pearson chi-squared and Kruskall-Wallis tests were used to compare descriptive statistics by race/ethnicity. Outcomes included in-hospital mortality, discharge location, ambulation at discharge, modified Rankin Scale (mRS) score at discharge, and receiving comfort measures only. Logistic regression models with generalized estimating equations accounted for age, insurance, smoking, hypertension, diabetes, dyslipidemia, atrial fibrillation/flutter, coronary artery disease, peripheral vascular disease, prior stroke/TIA, carotid stenosis, prior anticoagulation or antiplatelet use, prior ambulatory status, arrival mode, admission NIHSS, Florida region, number of beds, years in GWTG, and teaching hospital status. Results: The sample consisted of 10, 559 records with SAH discharged between 2010-2018; 63% were non-Hispanic White (NHW), 19.4% non-Hispanic Black (NHB), and 17.6% Hispanic. NHB were younger at onset (median age=54, IQR=45-65; NHW: 62, 53-73; Hispanic: 58, 48-71; p < 0.0001) and had the highest rate of hypertension (62%; NHW: 50%, Hispanic: 51%; p < 0.001), while NHW had the highest rate of smoking (24%; NHB: 20%; Hispanic: 17%; p < 0.0001). NHB had lower odds of in-hospital mortality compared to NHW (adjusted OR 0.8, 95% CI 0.68-0.94), but were less likely to have been discharged home/rehab (0.83, 0.73-0.94), to ambulate independently at discharge (0.71, 0.60-0.84), and to have a discharge mRS score of 0-2 (0.67, 0.49-0.92). Conclusions: While NHB have lowered odds of dying in-hospital from SAH, survivors have worse functional outcomes. These race/ethnic disparities highlight the need for further research into the causes of these differences and to refine approaches to improve acute care of SAH.