Related Experiment Video
Updated: Jul 25, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Disparities in brain health comorbidity management in intracerebral hemorrhage
Ernst Mayerhofer1,2,3, Natalie O Zaba1,2,3, Livia Parodi1,2,3,4
1Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
Insights
Social determinants of health impact pre-ICH care for cardiovascular risk factors. Underserved populations face disparities in managing blood pressure, diabetes, and hyperlipidemia, highlighting a need for systematic intervention during hospitalization.
Area of Science:
- Neurology
- Public Health
- Cardiology
Background:
- Intracerebral hemorrhage (ICH) disproportionately affects underserved populations.
- ICH survivors face risks for cardiovascular events and cognitive decline.
- Social determinants of health (SDOH) are linked to these risk factors.
Purpose of the Study:
- To investigate associations between SDOH and the management of key health conditions in ICH patients.
- To examine the pre- and post-ICH hospitalization management of blood pressure, hyperlipidemia, diabetes, obstructive sleep apnea (OSA), and hearing impairment.
Main Methods:
- Analysis of 234 ICH survivors from a longitudinal study (2016-2019).
- Data collected from electronic health records, including BP, LDL, HbA1c, and referrals for OSA and hearing impairment.
- US-wide Area Deprivation Index (ADI) used as a proxy for SDOH.
Main Results:
- Higher ADI was associated with lower odds of pre-ICH measurement for BP, LDL, and HbA1c.
- Inadequate management was observed for off-target LDL (46%) and HbA1c (25%).
- Few patients were referred for OSA (23%) or hearing impairment (8%) evaluations.
Conclusions:
- SDOH significantly influence the pre-ICH management of cerebrovascular risk factors.
- Over 25% of patients lacked assessment for hyperlipidemia and diabetes, with suboptimal treatment intensification.
- Systematic evaluation and management of comorbidities during ICH hospitalization are crucial for improving long-term outcomes.
Background:
Intracerebral hemorrhage (ICH) disproportionally affects underserved populations, and coincides with risk factors for cardiovascular events and cognitive decline after ICH. We investigated associations between social determinants of health and management of blood pressure (BP), hyperlipidemia, diabetes, obstructive sleep apnea (OSA), and hearing impairment before and after ICH hospitalization.
Methods:
Survivors of the Massachusetts General Hospital longitudinal ICH study between 2016 and 2019 who received healthcare at least 6 months after ICH were analyzed. Measurements of BP, LDL and HbA1c and their management in the year surrounding ICH and referrals for sleep studies and audiology up to 6 months after ICH were gathered from electronic health records. The US-wide area deprivation index (ADI) was used as proxy for social determinants of health.
Results:
The study included 234 patients (mean 71 years, 42% female). BP measurements were performed in 109 (47%) before ICH, LDL measurements were performed in 165 (71%), and HbA1c measurements in 154 (66%) patients before or after ICH. 27/59 (46%) with off-target LDL and 3/12 (25%) with off-target HbA1c were managed appropriately. Of those without history of OSA or hearing impairment before ICH, 47/207 (23%) were referred for sleep studies and 16/212 (8%) to audiology. Higher ADI was associated with lower odds of BP, LDL, and HbA1c measurement prior to ICH [OR 0.94 (0.90-0.99), 0.96 (0.93-0.99), and 0.96 (0.93-0.99), respectively, per decile] but not with management during or after hospitalization.
Conclusion:
Social determinants of health are associated with pre-ICH management of cerebrovascular risk factors. More than 25% of patients were not assessed for hyperlipidemia and diabetes in the year surrounding ICH hospitalization, and less than half of those with off-target values received treatment intensification. Few patients were evaluated for OSA and hearing impairment, both common among ICH survivors. Future trials should evaluate whether using the ICH hospitalization to systematically address co-morbidities can improve long-term outcomes.
