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Original research
Factors influencing the incidence and treatment of intracranial aneurysm and subarachnoid hemorrhage: time trends and socioeconomic disparities under an universal healthcare system
  1. Won Kyung Lee1,2,
  2. Chang Wan Oh3,
  3. Heeyoung Lee4,
  4. Kun Sei Lee5,
  5. Hyeonseon Park6
  1. 1Department of Prevention and Management, Inha University Hospital, Incheon, Republic of Korea
  2. 2School of Medicine, Inha University, Incheon, Republic of Korea
  3. 3Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  4. 4Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  5. 5Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Republic of Korea
  6. 6Department of Social and Preventive Medicine, School of Medicine, Inha University, Incheon, Republic of Korea
  1. Correspondence to Dr. Hyeonseon Park, Department of Neurosurgery, School of Medicine, Inha University, Incheon 22212, Republic of Korea; hspark{at}inha.ac.kr

Abstract

Background Despite increasing usage of endovascular treatments for intracranial aneurysms, few research studies have been conducted on the incidence of unruptured aneurysm (UA) and subarachnoid hemorrhage (SAH), and could not show a decrease in the incidence of SAH. Moreover, research on socioeconomic disparities with respect to the diagnosis and treatment of UA and SAH is lacking.

Method Trends in the incidences of newly detected UA and SAH and trends in the treatment modalities used were assessed from 2005 to 2015 using the nationwide database of the Korean National Health Insurance Service in South Korea. We also evaluated the influence of demographic characteristics including socioeconomic factors on the incidence and treatment of UA and SAH.

Result The rates of newly detected UA and SAH were 28.3 and 13.7 per 100 000 of the general population, respectively, in 2015. The incidence of UA increased markedly over the 11-year study period, whereas that of SAH decreased slightly. UA patients were more likely to be female, older, employee-insured, and to have high incomes than SAH patients. In 2015, coiling was the most common treatment modality for both UA and SAH patients. Those who were female, employee-insured, or self-employed, with high income were likely to have a higher probability to be treated for UA and SAH.

Conclusion The marked increase in the detection and treatment of UA might have contributed to the decreasing incidence of SAH, though levels of contribution depend on socioeconomic status despite universal medical insurance coverage.

  • aneurysm
  • subarachnoid
  • hemorrhage
  • coil
  • statistics

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Footnotes

  • Contributors Study conception and design (CWO, HP, JSL). Statistics (WKL, HL). Manuscript composition (WKL, HP). All authors reviewed the manuscript, provided critical review, and provided final approval of the manuscript to be published.

  • Funding This work was supported by the National Research Foundation of Korea (NRF) and Inha University Hospital funded by the Korean government (MSIT) (NRF-2017R1C1B5017736) and Inha University Hospital Research Grant.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board of Inha University Hospital (2017-04-011).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Limited access was allowed to the database of the Korean National Health Insurance Service, which were used under license for the current study, and so are not publicly available.

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