Background There are race and socioeconomic disparities in the nationwide treatment of unruptured intracranial aneurysm. Current publications on disparities in treatment and outcomes of aneurysmal subarachnoid hemorrhage (aSAH) are limited to institutional or regional studies. This paper aims to trend progress of equitable care and outcomes in aSAH care on a national level.

Methods The National Inpatient Sample database (NIS) was queried for patient admissions with ruptured aSAH for the years 2016-2020. Patients with the ICD-10 diagnosis 160.00 - 160.09 were included in the study. Univariate and multivariate analysis was performed, accounting for the sampling design of the NIS, estimating impacts of socioeconomic status and race on rates of unfavorable outcomes, defined by mortality, delays in treatment, receipt of life sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, and blood transfusions), and unfavorable discharge status.

Results 117,350 patients were included in the study. Although minority patients had a longer interval from admission to aneurysm treatment (35 vs 41 hours, p < 0.001), they had a slightly higher odds of receiving treatment following aSAH (OR 1.15, 95% CI 1.12 – 1.18, p < 0.001) and lower odds of death (OR 0.96, 95% CI 0.93 – 0.99, p < 0.001). However, minority patients were also more likely to undergo mechanical ventilation (OR 1.13, 95% CI 1.07 - 1.14, p <0.001), tracheostomy tube placement (OR 1.39, 95% CI 1.31 - 1.47, p < 0.001), and blood transfusions (OR 1.48, 95% CI 1.41 - 1.56, p < 0.001). Individually, every minority race was more likely than White patients to undergo tracheostomy tube placement and blood transfusions. In addition, minority patients were found to have a higher rate of unfavorable discharge compared to White patients (OR 1.10, 95% CI 1.07 - 1.13, p < 0.001), longer length of stay (11 vs 13 days, p < 0.001), and higher cost of treatment ($ 239 290 vs $ 303 946, p < 0.001). Some of these disparities persisted when comparing high socioeconomic status (SES) minorities to low and high SES White patients. Patients from the lowest SES quartile of median household income were more likely to have delays in treatment and less likely to have aneurysm treatment than patients from the highest SES quartile (OR 0.83, 95% CI 0.80 – 0.85, p < 0.001). Overall, low SES was associated with less interventions and healthcare utilization yet higher cost ($ 252 029 vs $ 284 032, p < 0.001).

Conclusions Racial and socioeconomic disparities are present in treatment and outcomes following aSAH. When compared to White patients, minority patients are more likely to have delays in treatment, receive life-sustaining interventions, and have unfavorable discharge. LSES was associated with less interventions following aSAH.

Note: All significant values defined as p < 0.05 and are in bold text within the table; Abbreviations: LOS: Length of Stay; OR: Odds Ratio; AMA: Against Medical Advice

Disclosures J. Kabangu: None. C. Heskett: None. J. Peterson: None. K. Ebersole: None.