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. 2020 Jan 21;94(3):e314-e322.
doi: 10.1212/WNL.0000000000008737. Epub 2019 Dec 12.

Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Audrey C Leasure  1 , Zachary A King  1 , Victor Torres-Lopez  1 , Santosh B Murthy  1 , Hooman Kamel  1 , Ashkan Shoamanesh  1 , Rustam Al-Shahi Salman  1 , Jonathan Rosand  1 , Wendy C Ziai  1 , Daniel F Hanley  1 , Daniel Woo  1 , Charles C Matouk  1 , Lauren H Sansing  1 , Guido J Falcone  1 , Kevin N Sheth  2
Affiliations

Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Audrey C Leasure et al. Neurology. .

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.

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Figures

Figure 1
Figure 1. Study selection criteria
Flowchart summarizing sequential application of selection criteria for this study. ICH = intracerebral hemorrhage.
Figure 2
Figure 2. Risk of intracerebral hemorrhage (ICH) recurrence by race/ethnicity
Survival curve summarizing the risk of ICH recurrence over time by race/ethnicity.
Figure 3
Figure 3. Risk of intracerebral hemorrhage (ICH) recurrence by insurance payer
Survival curve summarizing the risk of ICH recurrence over time by insurance payer.
See this image and copyright information in PMC

Comment in

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