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Racial/ethnic disparities in hospital utilization in intracerebral hemorrhage

Salvador Cruz-Flores¹, Gustavo J Rodriguez¹, Mohammad Rauf A Chaudhry¹

¹Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.

International Journal of Stroke : Official Journal of the International Stroke Society

|March 15, 2019

Insights

Racial and ethnic minorities with intracerebral hemorrhage (ICH) utilized more life-saving procedures and had longer hospital stays. Whites experienced higher in-hospital mortality, palliative care, and do-not-resuscitate orders, suggesting potential disparities in care.

Area of Science:

Neurology
Public Health
Health Services Research

Background:

Racial and ethnic disparities in intracerebral hemorrhage (ICH) patient care are suspected.
Understanding variations in hospital utilization among diverse patient groups is crucial.

Purpose of the Study:

To investigate disparities in hospital utilization for intracerebral hemorrhage (ICH) patients across different racial and ethnic groups in the United States.

Main Methods:

Utilized the Nationwide Inpatient Sample database (2006-2014) to identify ICH patients.
Compared five race/ethnic categories on demographics, comorbidities, disease severity, complications, procedures, length of stay (LOS), charges, mortality, palliative care (PC), and do not resuscitate (DNR) orders.

Main Results:

Minorities showed higher rates of in-hospital complications, procedures, mean LOS, and hospital charges compared to Whites.
Whites had higher rates of in-hospital mortality, PC, and DNR.
Multivariable analysis confirmed minorities received more mechanical ventilation, tracheostomy, transfusions, and gastrostomy; Hispanics and Others had higher rates of specific cranial procedures.

Conclusions:

Minority ICH patients experienced greater use of life-sustaining and life-saving interventions and longer LOS.
White patients had increased utilization of palliative care and higher in-hospital mortality.
Observed differences may stem from cultural factors or access to care, warranting further investigation.

Read full analysis

Abstract

Background And Purpose:

There is evidence that racial and ethnic differences among intracerebral hemorrhage (ICH) patients exist. We sought to establish the occurrence of disparities in hospital utilization in the United States.

Methods:

We identified ICH patients from United States Nationwide Inpatient Sample database for years 2006-2014 using codes (DX1 = 431, 432.0) from the International Classification of Diseases, 9th edition. We compared five race/ethnic categories: White, Black, Hispanic, Asian or Pacific Islander, and Others ( Native American and other) with regard to demographics, comorbidities, disease severity, in-hospital complications, in-hospital procedures, length of stay (LOS), total hospital charges, in-hospital mortality, palliative care, (PC) and do not resuscitate (DNR). We categorized procedures as lifesaving (i.e. ventriculostomy, craniotomy, craniectomy, and ventriculoperitoneal (VP) shunt), life sustaining (i.e. mechanical ventilation, tracheostomy, transfusions, and gastrostomy). White race/ethnicity was set as the reference group.

Results:

Out of 710,293 hospitalized patients with ICH 470,539 (66.2%), 114,821 (16.2%), 66,451 (9.3%), 30,297 (4.3%) and 28,185 (3.9%) were White, Black, Hispanic, Asian or Pacific Islander, and Others, respectively. Minorities (Black, Hispanic, Asian or Pacific Islander, and Others) had a higher rate of in-hospital complications, in-hospital procedures, mean LOS, and hospital charges compared to Whites. In contrast, Whites had a higher rate of in-hospital mortality, PC, and DNR. In multivariable analysis, all minorities had higher rate of MV, tracheostomy, transfusions, and gastrostomy compared to Whites, while Hispanics had higher rate of craniectomy and VP shunt; and Asian or Pacific Islander and Others had higher rate of craniectomy. Whites had a higher rate of in-hospital mortality, palliative care, and DNR compared to minorities. In mediation analysis, in-hospital mortality for whites remained high after adjusting with PC and DNR.

Conclusion:

Minorities had greater utilization of lifesaving and life sustaining procedures, and longer LOS. Whites had greater utilization of palliative care, hospice, and higher in-hospital mortality. These results may reflect differences in culture or access to care and deserve further study.

Keywords:

Do not resussiate in-hospital mortality in-hospital utilization intracerebral hemorrhage palliative care racial disparities

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