Abstract Details

Title Racial/Ethnic Disparities in the Risk of Intracerebral Hemorrhage Recurrence

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S15 - Intracerebral Hemorrhage and SAH (1:44 PM-1:55 PM)

Poster/Presentation
Number 005

Background Race/ethnicity is associated with risk of first-ever ICH, but the influence of race/ethnicity on risk of ICH recurrence has not been well studied in a large, diverse population.

Objective To determine the risk of spontaneous intracerebral hemorrhage (ICH) recurrence and identify factors associated with recurrence in a large, racially and ethnically diverse population.

Design/Methods We used claims data on all hospitalizations in nonfederal acute care California hospitals between January 1, 2005 and December 31, 2011 to identify patients who were hospitalized for ICH. California residents who survived to discharge were included. We used validated diagnosis codes to identify a primary outcome of recurrent ICH. We then used survival curves and log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with the risk of ICH recurrence after adjusting for potential confounders.

Results

We identified 31,554 California residents with first-recorded ICH who survived to discharge, of which 15,828 (50%) were white, 6,254 (20%) Hispanic, 4,268 (14%) Asian, and 2,820 (9%) black. There were 1339 recurrences (4.2%) over a median follow-up time of 2.9 years (IQR 3.8). The 1-year recurrence rate was 3.0% (95% CI 2.8%-3.2%). In multivariable analysis, blacks (HR 1.22, 95% CI 1.01-1.48; p=0.04) and Asians (HR 1.29, 95% CI 1.10-1.50; p=0.001) had a higher risk of ICH recurrence than whites (reference category). Private insurance was associated with a significant reduction in the risk of ICH recurrence compared to subjects 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 subjects had a higher risk of ICH recurrence than whites, whereas private insurance was associated with a reduced risk of ICH recurrence compared to subjects with Medicare. Further research is needed to determine drivers of these disparities.

Authors/Disclosures
Audrey Leasure PRESENTER	Ms. Leasure has nothing to disclose.
Zachary King (Yale)	No disclosure on file
Victor M. Torres-Lopez, MA (Yale University)	Mr. Torres-Lopez has nothing to disclose.
Santosh B. Murthy, MD (Weill Cornell Medicine)	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Ashkan Shoamanesh, MD	Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer AG. Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo . Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Servier Inc.. Dr. Shoamanesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurodiem.ca. The institution of Dr. Shoamanesh has received research support from Servier Canada Inc.. The institution of Dr. Shoamanesh has received research support from Daiichi Sankyo Ltd.. The institution of Dr. Shoamanesh has received research support from Bayer AG. The institution of Dr. Shoamanesh has received research support from Bristol-Myers Squibb. The institution of Dr. Shoamanesh has received research support from Octapharma Canada .
	No disclosure on file
Jonathan Rosand, MD (Massachusetts General Hospital)	Dr. Rosand has received personal compensation for serving as an employee of Massachusetts General Hospital. Dr. Rosand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Rosand has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for National Football League. The institution of Dr. Rosand has received research support from NIH. The institution of Dr. Rosand has received research support from American Heart Association. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as a Peer reviewer with National Institutes of Health. Dr. Rosand has a non-compensated relationship as a Trustee with Columbia University that is relevant to AAN interests or activities.
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care)	Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lumosa. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bard. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received research support from NIH. Dr. Ziai has received publishing royalties from a publication relating to health care. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology)	Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
Daniel Woo, MD, FAAN (University at Buffalo)	The institution of Dr. Woo has received research support from NIH.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.

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