Racial and Ethnic Disparities in Treatment Outcomes of Patients with Ruptured or Unruptured Intracranial Aneurysms (original) (raw)
Related papers
Explaining racial disparities in mortality after abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2009
Background: Black patients have a higher mortality rate than nonblacks after abdominal aortic aneurysm repair. We sought to understand the factors responsible for this racial disparity in the mortality rate after aneurysm repair. Methods: The Medicare database (2001)(2002)(2003)(2004)(2005)(2006) was used to identify 160,785 patients undergoing open and endovascular abdominal aortic aneurysm repairs. We used risk-adjusted mortality as our primary measure of quality and logistic regression to determine the relationship between race and mortality, sequentially adding contributing factors including patient characteristics, the type of repair (endovascular vs open repair), socioeconomic status, and hospital quality. From these sequential regression models, we estimated the proportion of the disparity that can be explained by each factor. Results: Black patients had a 36% higher risk-adjusted mortality after aneurysm repair than nonblack patients (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20-1.53). Even after accounting for the type of repair, a significant difference in mortality remained (OR, 1.33; 95% CI, 1.18-1.50). Mortality rates were higher in hospitals treating a higher proportion of black patients. Adjusting for these differences in hospital quality, this disparity was no longer significant (OR, 1.07; 95% CI, 0.93-1.25). We estimate that 29% of the observed disparity in mortality is caused by patient comorbidities, 6% from the use of endovascular repairs, 26% due to socioeconomic factors, and 25% because black patients receive care in lower-quality hospitals. Conclusions: Although many factors contribute, a large proportion of observed disparities in outcomes are attributable to black patients receiving care in lower-quality hospitals. Efforts aimed at improving disparities must focus on improved access to high-quality hospitals and improved resources at the hospitals that treat higher proportions of black patients. ( J Vasc Surg 2009;50:709-13.) From the Michigan Surgical Collaborative for Outcomes
Stroke, 2007
Race/ethnicity is associated with overall incidence of intracranial hemorrhage (ICH), but its impact in patients with brain arteriovenous malformation is unknown. We evaluated whether race/ethnicity was a risk factor for ICH in the natural course in a large, multiethnic cohort of patients with brain arteriovenous malformation followed longitudinally. Data were collected prospectively for patients with brain arteriovenous malformation evaluated at the University of California, San Francisco (n=436) and retrospectively through databases and chart review in the 20 hospitals of the Kaiser Permanente Medical Care Program (n=1028). Multivariate Cox regression was performed to assess the influence of race/ethnicity on subsequent ICH, adjusting for risk factors. Cases were censored at first treatment, loss to follow-up, or death. Average follow up was 4.7+/-8.0 years for Kaiser Permanente Medical Care Program patients and 2.8+/-7.3 years for University of California, San Francisco patients with no difference in time to ICH between cohorts (log rank P=0.57). The annualized 5-year ICH rate was 2.1% (3.7% for ruptured at presentation; 1.4% for unruptured). Initial ICH presentation (hazard ratio: 3.0, 95% CI: 1.9 to 4.9, P<0.001) and Hispanic race/ethnicity (hazard ratio: 1.9, 95% CI: 1.1 to 3.3, P=0.02) were independent predictors of ICH, adjusting for age, gender, cohort, and a cohort-age interaction. The ICH risk for Hispanics versus whites increased to 3.1 (95% CI: 1.3 to 7.4, P=0.013) after further adjusting for arteriovenous malformation size and deep venous drainage in a subset of cases with complete data. Similar trends were observed for blacks (hazard ratio: 2.1, 95% CI: 0.9 to 4.8, P=0.09) and Asians (hazard ratio: 2.4, 95% CI: 0.8 to 7.1, P=0.11), although nonsignificant. This study reports the first description of race/ethnic differences in brain arteriovenous malformation, with Hispanics at an increased risk of subsequent ICH compared with whites.
The impact of race and ethnicity on the outcome of carotid interventions in the United States
Journal of Surgical Research, 2012
Objective: Previous studies have demonstrated an adverse impact of African American race and Hispanic ethnicity on the outcomes of carotid endarterectomy (CEA), although little is known about the influence of race and ethnicity on the outcome of carotid angioplasty and stenting (CAS). The present study was undertaken to examine the influence of race and ethnicity on the outcomes of CEA and CAS in contemporary practice. Methods: The nationwide inpatient sample (2005e2008) was queried using International Classification of Diseases-9 codes for CEA and CAS in patients with carotid artery stenosis. The primary outcomes were postoperative death or stroke. Multivariate analysis was performed adjusting for age, gender, race, comorbidities, high-risk status, procedure type, symptomatic status, year, insurance type, and hospital characteristics. Results: Overall, there were 347,450 CEAs and 47,385 CASs performed in the United States over the study period. After CEA, Hispanics had the greatest risk of mortality (P < 0.001), whereas black patients had the greatest risk of stroke (P ¼ 0.02) compared with white patients on univariate analysis. On multivariable analysis, Hispanic ethnicity remained an independent risk factor for mortality after CEA (relative risk 2.40; P < 0.001), whereas the increased risk of stroke in black patients was no longer significant. After CAS, there were no racial or ethnic differences in mortality. On univariate analysis, the risk of stroke was greatest in black patients after CAS (P ¼ 0.03). However, this was not significant on multivariable analysis. Conclusion: Hispanic ethnicity is an independent risk factor for mortality after CEA. While black patients had an increased risk of stroke after CEA and CAS, this was explained by factors other than race. Further studies are warranted to determine if Hispanic ethnicity remains an independent risk factor for mortality after discharge.
Racial disparities in outcomes after intact abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2018
Objective-We aimed to compare perioperative morbidity and mortality and late survival amongst black, white, and Asian patients undergoing intact AAA repair. Methods-We identified all patients undergoing intact, infrarenal AAA repair in the VQI from 2003-2017. We compared in-hospital outcomes by race using the Fisher Exact and Kruskal Wallis tests. Multivariable logistic and linear regression models of perioperative outcomes adjusted for differences in demographics, comorbidities, hospital volume, and procedure. We used Cox regression to evaluate late survival by race. Results-In the cohort, 21,961 (94%) patients were white, 1,215 (5.2%) were black, and 318 (1.4%) were Asian. Black patients were more likely to be symptomatic (Black:
Journal of the American Heart Association
Background The ISAT (International Subarachnoid Aneurysm Trial) has generated a paradigm shift towards endovascular treatment for intracranial aneurysms but remains unclear if this has led to a true reduction in the risk for aneurysmal subarachnoid hemorrhage (aSAH). We sought to study the association between the treatment burden of unruptured and ruptured aneurysms in the post‐ISAT era. Methods and Results Admissions data from the National Inpatient Sample (2004–2014) were extracted, including patients with a primary diagnosis of aSAH or unruptured intracranial aneurysms treated by clipping or coiling. Within each year, this combined group was randomly matched to non‐aneurysmal control group, based on age, sex, and Elixhauser comorbidity index. Multinomial regression was performed to calculate the relative risk ratio of undergoing treatment for either ruptured or unruptured aneurysms in comparison with the reference control group, adjusted for time. After adjusting for National Inp...
Annals of vascular surgery, 2013
Previous studies have demonstrated racial and ethnic disparities associated with the outcomes of abdominal aortic aneurysm (AAA) repair, although little is known about the influence of race and ethnicity on the costs associated with these disparities. The current study was undertaken to examine the influence of race and ethnicity on the outcomes of endovascular (EVAR) and open repair (open AAA) of unruptured AAA and its effect on costs in contemporary practice. The Nationwide Inpatient Sample (2005 to 2008) was queried using ICD-9-CM codes for unruptured AAA (441.4). The primary outcomes were mortality and total hospital charges. Multivariate analyses were performed adjusting for age, gender, race, comorbidities (Charlson index), year, insurance type, and hospital characteristics. A total of 62,728 patients underwent EVAR and 24,253 patients underwent open AAA. White patients (72%) were more likely to undergo EVAR than Hispanic (69%) or black patients (69%; P = 0.02). On univariate ...
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2017
Socio-economic status (SES) and ethnicity have been reported as markers influencing the likelihood of increased mortality. The aim of this study was to investigate how SES and ethnicity impacted patient survival after abdominal aortic aneurysm (AAA) repair. Consecutive patients undergoing open and endovascular AAA repair during a 14.5 year period were identified. Ethnicity was defined as recorded on health records and SES (a score of 10, where 1 is least deprived and 10 being most deprived) and was linked to census data. Operative outcomes were reported at 30 days and a medium-term survival analysis used the Cox model to report adjusted hazard ratios (HR). A total of 6239 patients with a median age of 75 years and 78.7% males were included. The majority (5,654) were identified as New Zealand (NZ) Europeans, with 421 identified as NZ Maori, 97 identified as belonging to a Pacific ethnic group, and 67 identified as an Asian ethnic group. The median survival follow-up period was 5 year...
Differences in intracerebral hemorrhage between Mexican Americans and non-Hispanic whites
Neurology, 2006
Background: Mexican Americans (MAs) have higher incidence rates of intracerebral hemorrhage (ICH) than non-Hispanic whites (NHWs). The authors present clinical and imaging characteristics of ICH in MAs and NHWs in a population-based study. Methods: This work is part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. Cases of nontraumatic ICH were identified from 2000 to 2003. Multivariable logistic regression was used to assess the independent associations between ethnicity and ICH location (lobar vs nonlobar) and volume (Ն30 vs Ͻ30 mL), adjusting for demographics and baseline clinical characteristics. Logistic regression was also used to determine the association between ethnicity and in-hospital mortality, adjusting for confounders. Results: A total of 149 MAs and 111 NHWs with ICH were identified. MAs were younger (70 vs 77, p Ͻ 0.001), more often male (55% vs 42%, p ϭ 0.04), had a lower prevalence of atrial fibrillation (2.0% vs 13%, p Ͻ 0.001), and a higher prevalence of diabetes (39% vs 19%, p Ͻ 0.001). MA ethnicity was independently associated with nonlobar hemorrhage (OR 2.08, 95% CI: 1.15, 3.70). MAs had over two times the odds of having small (Ͻ30 mL) hemorrhages compared with NHWs (OR ϭ 2.41, 95% CI: 1.31, 4.46). NHWs had higher in-hospital mortality, though this association was no longer significant after adjustment for ICH volume, location, age, and sex. Conclusions: There are significant differences in the characteristics of ICH in MAs and NHWs, with MA patients more likely to have smaller, nonlobar hemorrhages. These differences may be used to examine the underlying pathophysiology of ICH.