Abstract WP83: Racial and Gender Disparities in the Treatment of Cerebral Aneurysms in the United States: The Gap is Narrowing
Abbreviations: SAH, subarachnoid hemorrhage. BWH, Brigham and Women’s Hospital, Boston. ISAT, International Subarachnoid Aneurysm Trial.
Background: Cerebral aneurysms may be treated with surgical clipping or endovascular coiling. We investigate treatment choice and outcome of cerebral aneurysms by race and gender in the United States over the past decade.
Methods: Data are the Nationwide Inpatient Sample data from 1998 to 2007. Patients undergoing treatment for cerebral aneurysm were identified by ICD-9 codes with hospital mortality and adverse discharge disposition (other than home) examined as as outcome parameters using logistic regression.
Results: Of all aneurysms treated in the U.S. from 1998-2007, 20134 were ruptured and 14765 were unruptured. Over this decade, the use of endovascular coiling increased in all racial and gender subgroups for both ruptured and unruptured patients. Whites were more likely than non-whites to undergo coiling for a ruptured aneurysm (Odds Ratio [OR]: 1.30; 95% Confidence Interval [95%CI]: 1.13-1.48), and males with unruptured aneurysms were more likely than females to undergo coiling (OR: 1.26; 95%CI: 1.13-1.40). Hospital mortality and adverse discharge disposition were more likely in black females with unruptured aneurysms than other subgroups. Treatment selection and outcome across racial and gender subgroups did not vary by geographic areas or hospital teaching status. By 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant.
Conclusions: Racial and gender disparities exist in cerebral aneurysm treatment and outcome in the United States, although the differences in treatment selection were decreased over time.
- © 2012 by American Heart Association, Inc.