Disparities in Functional Outcome After Intracerebral Hemorrhage Among Asians and Pacific Islanders.

Kazuma Nakagawa,Marjorie K L M Mau,Sage L King,Todd B Seto

doi:10.3389/fneur.2018.00186

Kazuma Nakagawa, Marjorie K L M Mau + Show 2 more

Open Access

https://doi.org/10.3389/fneur.2018.00186

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Abstract

Disparities in outcome after intracerebral hemorrhage (ICH) among Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have been inadequately studied. We sought to assess differences in functional outcome between Asians and NHOPI after ICH. A multiracial prospective cohort study of ICH patients was conducted from 2011 to 2016 at a tertiary center in Honolulu, HI, USA to assess racial disparities in outcome after ICH. Favorable outcome was defined as 3-month modified Rankin Scale (mRS) score ≤2. Patients with no available 3-month functional outcome, race other than Asians and NHOPI, and baseline mRS > 0 were excluded. Multivariable analyses using logistic regression were performed to assess the impact of race on favorable outcome after adjusting for the ICH Score, early do-not-resuscitate (DNR) order and dementia/cognitive impairment. A total of 220 patients (161 Asians, 59 NHOPI) were studied. Overall, 65 (29.5%) achieved favorable outcome at 3 months. NHOPI were younger than Asians (p < 0.0001) and had higher prevalence of diabetes (p = 0.007), obesity (p < 0.0001), and lower prevalence of dementia/cognitive impairment (p = 0.02), early DNR order (p = 0.0004), and advance directive presence (p = 0.0005). NHOPI race was a predictor of favorable outcome in the unadjusted model [odds ratio (OR) 2.47, 95% confidence interval (CI): 1.32-4.62] and after adjusting for the ICH Score (OR 2.30, 95% CI: 1.06-4.97) but not in the final model (OR 2.04, 95% CI: 0.94-4.42). In the final model, the ICH Score was the only independent negative predictor of outcome (OR 0.26, 95% CI: 0.17-0.41 per point). NHOPI are more likely to achieve favorable functional outcome after ICH compared with Asians even after controlling for ICH severity. However, this association was attenuated by the DNR and dementia/cognitive impairment status.

Highlights

Intracerebral hemorrhage (ICH) has disproportionately high mortality and morbidity with only 21–31% of patients gaining functional independence at 3 months (1–3)
Our results showed that 29.5% of the ICH patients achieved favorable functional outcome at 3 months, which is consistent with the prior studies (1–3)
Native Hawaiians and Other Pacific Islanders (NHOPI) in our study were more likely to achieve favorable 3-month functional outcome compared with Asians after adjusting for the ICH Score

Summary

Introduction

Intracerebral hemorrhage (ICH) has disproportionately high mortality and morbidity with only 21–31% of patients gaining functional independence at 3 months (1–3). Prior studies that assessed racial/ethnic disparities in ICH have shown that minority groups, African Americans and Hispanics, have a higher incidence of ICH and younger age of presentation than whites (4, 5). Asians are estimated to have a higher incidence of ICH compared with Caucasians (6). More recent studies have shown comparable or better outcomes after ICH among blacks and Hispanics compared with whites (3, 12). A few studies that assessed Asians showed lower risk-adjusted mortality after ICH and ischemic stroke compared with whites. Disparities in outcome after intracerebral hemorrhage (ICH) among Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have been inadequately studied. We sought to assess differences in functional outcome between Asians and NHOPI after ICH

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