Introduction: Women and minorities are reported to have worse outcomes and higher in-hospital mortality (IHM) after ischemic stroke. However, sex and racial differences for IHM after intracerebral hemorrhage (ICH) are still uncertain.
Methods: Using administrative data on all discharges from acute care hospitals in California (2005-2011) and Florida (2005-2014), we identified adult ICH patients (ICD-9 Code 431). We excluded patients who had a diagnosis of subarachnoid hemorrhage, arteriovenous malformation, trauma, or ischemic stroke. Logistic regression models were used to assess factors associated with IHM. We report odds ratios and 95% CIs.
Results: Among 82,613 ICH patients, 40,124 (48.7%) were female. Median (IQR) age was 72 (58-82), 14% were black, and 15% were Hispanic. In univariate analysis, females were older (OR 1.37, CI 1.29-1.45, age>60), had fewer extraventricular drains (EVD, OR 0.83, CI 0.74-0.95), and were less often intubated (OR 0.86, CI 0.84-0.89). Blacks had more EVDs (OR 2.5, CI 2.14-2.89), hemicraniectomys (OR 1.40, CI 1.12-1.75), and intubations (OR 1.55, CI 1.48-1.62) than whites. Hispanics were also intubated more often than whites (OR 1.19, CI 1.14-1.24). IHM rate was 24.2%. In univariate analysis, IHM was associated with female sex (OR 1.06, CI 1.03-1.10), age > 45 (OR 1.24, CI 1.14-1.34), black vs white race (OR 0.81, CI 0.77-0.85), Hispanic vs white race (OR 0.80, CI 0.76-0.84), history of hypertension (OR 0.85, CI 0.82-0.88), obesity (OR 0.71, CI 0.67-0.76), use of EVD (OR 1.48, CI 1.29-1.69), and intubation (OR 11.6, CI 11.2-12.0). In multivariate analysis, women were more likely to suffer IHM (OR 1.09, CI 1.05-1.13) and minorities were less likely to suffer IHM (OR 0.74, CI 0.70-0.79, black, and OR 0.70, CI 0.66-0.74, Hispanic) after adjusting for age, hypertension, obesity, use of EVD and hemicraniectomy.
Conclusions: In this large real-world cohort of ICH patients, female sex was associated with increased IHM, while black and Hispanic race were associated with lower rates of IHM compared to whites. These findings suggest disparities in the severity of this disease in these groups, or in the type of care provided to them.