Abstract WP376: Nationwide And Midsouth Regional Disparities In Mortality For African American And Caucasian Aneurysmal Subarachnoid Hemorrhage Patients

Abstract

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries high mortality rates, and disparities have been reported between Caucasian and African American (AA) patients. But little large-scale data are available to examine such differences. The purpose of this study is to compare demographics and mortality outcomes for Caucasian and AA aSAH subjects using both nationwide and midsouth regional datasets. Methods: The nationwide sample was selected from inpatient Cerner Health Facts EMR data made available through UTHSC Center for Biomedical Informatics. The midsouth regional sample was selected from the Semmes Murphey neurosurgical clinic EMR. All subjects were selected by ICD-9 code and were seen from 2004-2016. Available demographics included age, race, gender, and admission Glasgow Coma Scale (GCS) score. Primary outcome was mortality at any time in the first month post-admission. Descriptive statistics were calculated and associations with mortality outcomes examined using t-tests, chi squares, and ANOVA as appropriate. Significance was set at p ≤0.05. Results: In the nationwide dataset (N=3,924, 24% AA, 57% female), AA aSAH patients were nearly 8 years younger than Caucasians (mean age 53.7 ± 17.6 vs 61.4 ± 18.9, p <0.0001) and had poorer admission GCS scores (mean 11.5 ± 3.5 versus 10.8 ± 3.6, p <0.0001). These disparities were less marked for the regional sample (N=1,144, 44% AA, 67% female), where AA were <6 years younger (mean age 51.1 ± 13.6 vs. 56.8 ± 14.0, p <0.0001), and GCS scores were not significantly different between races (11.2 ± 4.9, 10.8 ± 4.6, p =0.16). Despite an improvement in these demographic disparities locally, regional AA have similar GCS scores as the nationwide sample ( p =0.85) and are more likely than Caucasians to die within 1 month of admission regionally ( p =0.003) and nationwide ( p =0.0007). Conclusions: AA aSAH patients experience increased mortality as compared to Caucasians both nationwide and regionally. From this limited observational data it is not clear what other factors could be contributing to these disparities in mortality. Future work in such disparities should include more complete demographic and clinical data, information on health services access, quality, and utilization, and preexisting comorbidities.