Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities: Analysis of nationally representative data

Abdulaziz T. Bako, Thomas Potter, Alan P. Pan, Karim A. Borei, Taya Prince, Gavin W. Britz, Farhaan S. Vahidy

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article numbere000511
Pages (from-to)e000511
JournalBMJ Neurology Open
Volume6
Issue number1
DOIs
StatePublished - Jan 12 2024

Keywords

  • COVID-19
  • NEUROEPIDEMIOLOGY
  • STROKE
  • SUBARACHNOID HAEMORRHAGE

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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