TY - JOUR
T1 - Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities
T2 - Analysis of nationally representative data
AU - Bako, Abdulaziz T.
AU - Potter, Thomas
AU - Pan, Alan P.
AU - Borei, Karim A.
AU - Prince, Taya
AU - Britz, Gavin W.
AU - Vahidy, Farhaan S.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/1/12
Y1 - 2024/1/12
N2 - Background Nationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking. Methods In this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016-2020). We evaluated differences in rates of in-hospital outcomes between the prepandemic (January 2016-February 2020) and pandemic (March-December 2020) periods using segmented logistic regression models. We used multivariable logistic regression to evaluate differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted from April to December 2019. Stratified analyses were conducted among patients residing in low-income and high-income zip codes, as well as among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF). Results Overall, 309 965 patients with ICH (47% female, 56% low income) and 112 210 patients with SAH (62% female, 55% low income) were analysed. Prepandemic, ICH mortality decreased by ∼1% per month (adjusted OR, 95% CI: 0.99 (0.99 to 1.00); p<0.001). However, during the pandemic, the overall ICH mortality rate increased, relative to prepandemic, by ∼2% per month (1.02 (1.00 to 1.04), p<0.05) and ∼4% per month (1.04 (1.01 to 1.07), p<0.001) among low-income patients. There was no significant change in trend among high-income patients with ICH (1.00 (0.97 to 1.03)). Patients with comorbid COVID-19 in 2020 had higher odds of mortality (versus 2019 cohort) only among patients with MM-LoF (ICH, 2.15 (1.12 to 4.16), and SAH, 5.77 (1.57 to 21.17)), but not among patients with E-LoF. Conclusion Sustained efforts are needed to address socioeconomic disparities in healthcare access, quality and outcomes during public health emergencies.
AB - Background Nationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking. Methods In this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016-2020). We evaluated differences in rates of in-hospital outcomes between the prepandemic (January 2016-February 2020) and pandemic (March-December 2020) periods using segmented logistic regression models. We used multivariable logistic regression to evaluate differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted from April to December 2019. Stratified analyses were conducted among patients residing in low-income and high-income zip codes, as well as among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF). Results Overall, 309 965 patients with ICH (47% female, 56% low income) and 112 210 patients with SAH (62% female, 55% low income) were analysed. Prepandemic, ICH mortality decreased by ∼1% per month (adjusted OR, 95% CI: 0.99 (0.99 to 1.00); p<0.001). However, during the pandemic, the overall ICH mortality rate increased, relative to prepandemic, by ∼2% per month (1.02 (1.00 to 1.04), p<0.05) and ∼4% per month (1.04 (1.01 to 1.07), p<0.001) among low-income patients. There was no significant change in trend among high-income patients with ICH (1.00 (0.97 to 1.03)). Patients with comorbid COVID-19 in 2020 had higher odds of mortality (versus 2019 cohort) only among patients with MM-LoF (ICH, 2.15 (1.12 to 4.16), and SAH, 5.77 (1.57 to 21.17)), but not among patients with E-LoF. Conclusion Sustained efforts are needed to address socioeconomic disparities in healthcare access, quality and outcomes during public health emergencies.
KW - COVID-19
KW - NEUROEPIDEMIOLOGY
KW - STROKE
KW - SUBARACHNOID HAEMORRHAGE
UR - http://www.scopus.com/inward/record.url?scp=85183020399&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183020399&partnerID=8YFLogxK
U2 - 10.1136/bmjno-2023-000511
DO - 10.1136/bmjno-2023-000511
M3 - Article
AN - SCOPUS:85183020399
SN - 2632-6140
VL - 6
JO - BMJ Neurology Open
JF - BMJ Neurology Open
IS - 1
M1 - e000511
ER -