Published Online
on August 2, 2007

A more recent version of this article appeared on September 1, 2007

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Submitted on February 16, 2007
Accepted on March 20, 2007

Racial/Ethnic Differences in Longitudinal Risk of Intracranial Hemorrhage in Brain Arteriovenous Malformation Patients

Helen Kim PhD^*; Stephen Sidney MD, MPH; Charles E. McCulloch PhD; K. Y. Trudy Poon MS; Vineeta Singh MD; S. Claiborne Johnston MD, PhD; Nerissa U. Ko MD; Achal S. Achrol BS; Michael T. Lawton MD; Randall T. Higashida MD; William L. Young MD; for the UCSF BAVM Study Project

From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (H.K., K.Y.T.P., A.S.A., W.L.Y.), the Departments of Epidemiology and Biostatistics (C.E.M., S.C.J.), Neurological Surgery (M.T.L., W.L.Y.), Neurology (V.S., S.C.J., N.U.K., W.L.Y.), and Radiology (R.T.H.), University of California, San Francisco, Calif; and the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland, Calif.

^* To whom correspondence should be addressed. E-mail: kimhel{at}anesthesia.ucsf.edu.

Background and Purpose—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.

Methods—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.

Results—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.

Conclusions—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.

Key words: brain arteriovenous malformation • hemorrhage • racial differences • risk factor • survival

Related Article:

When Race/Ethnicity Matters More Than Size

Alexander V. Khaw
Stroke 2007 38: 2405-2406. [Extract] [Full Text] [PDF]

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