Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample
Objectives To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA. Methods We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariabl...
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| Veröffentlicht in: | Neurocritical care 2020-06, Vol.32 (3), p.715-724 |
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| creator | Otite, Fadar Oliver Akano, Emmanuel Oladele Akintoye, Emmanuel Khandelwal, Priyank Malik, Amer M. Chaturvedi, Seemant Rosand, Jonathan |
| description | Objectives
To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA.
Methods
We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariable-adjusted models to compare odds of mortality between rural and urban hospitals. Joinpoint regression was used to evaluate trends in age- and sex-adjusted mortality in rural and urban hospitals over time.
Results
From 2004 to 2014, 5.8% of ICH patients were admitted in rural hospitals. Rural patients were older (mean [SE] 76.0 [0.44] years vs. 68.8 [0.11] years in urban), more likely to be white and have Medicare insurance. Age- and sex-adjusted mortality was greater in rural hospitals (32.2%) compared to urban patients (26.5%) (
p
value |
| doi_str_mv | 10.1007/s12028-020-00950-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7223184</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2919713122</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-da6e4b2b7bba9f3a5e698172af5e33a88d0254d6b3aee3b53af11eb177d6a1c73</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EouXAC7BAltiwCfiSxAkLpKpQeqRyEeWsrXEyOcdVYqd2gtQdEo_AG_IkOD2lXBasPNJ883v--Ql5zNlzzph6EblgosqYYBljdcEycYcc8qIoM1aX_O5S5zwraykPyIMYLxgTqlbFfXIghZBCifKQfPs0B-h_fP2-CQYcfW3jCMFOFiO1jq7dFKDBgCZB9BQHH8IOtkjf-TBBb6erhZp2SDfnRy_px4C9HayDcEVPrGut20baBT9cI-9hst4lnbUbU4luoucwjD0-JPc66CM-unlXZHPy5vPxaXb24e36-Ogsa3KVT1kLJeZGGGUM1J2EAsu64kpAV6CUUFUtE0XelkYCojSFhI5zNFyptgTeKLkir_a642wGbBtc3PV6DHZIG2sPVv_dcXant_6LVulcvMqTwLMbgeAvZ4yTHmxssO_BoZ-jFrIq0llTGAl9-g964eeQ3Ceq5rXikifRFRF7qgk-xoDd7TKc6SVjvc9Yp4z1dcZ6GXryp43bkV-hJkDugZhabovh99__kf0JT5e1wQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919713122</pqid></control><display><type>article</type><title>Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample</title><source>MEDLINE</source><source>ProQuest Central (Alumni Edition)</source><source>ProQuest Central UK/Ireland</source><source>SpringerLink Journals - AutoHoldings</source><source>ProQuest Central</source><creator>Otite, Fadar Oliver ; Akano, Emmanuel Oladele ; Akintoye, Emmanuel ; Khandelwal, Priyank ; Malik, Amer M. ; Chaturvedi, Seemant ; Rosand, Jonathan</creator><creatorcontrib>Otite, Fadar Oliver ; Akano, Emmanuel Oladele ; Akintoye, Emmanuel ; Khandelwal, Priyank ; Malik, Amer M. ; Chaturvedi, Seemant ; Rosand, Jonathan</creatorcontrib><description>Objectives
To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA.
Methods
We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariable-adjusted models to compare odds of mortality between rural and urban hospitals. Joinpoint regression was used to evaluate trends in age- and sex-adjusted mortality in rural and urban hospitals over time.
Results
From 2004 to 2014, 5.8% of ICH patients were admitted in rural hospitals. Rural patients were older (mean [SE] 76.0 [0.44] years vs. 68.8 [0.11] years in urban), more likely to be white and have Medicare insurance. Age- and sex-adjusted mortality was greater in rural hospitals (32.2%) compared to urban patients (26.5%) (
p
value < 0.001). After multivariable adjustment, patients hospitalized in rural hospitals had two times the odds of in-hospital death compared to patients in urban hospitals (OR 2.07, 95% CI 1.77–2.41.
p
value < 0.001). After joinpoint regression, mortality declined in urban hospitals by an average of 2.8% per year (average annual percentage change, [AAPC] − 2.8%, 95% CI − 3.7 to − 1.8%), but rates in rural hospitals remained unchanged (AAPC − 0.54%, 95% CI − 1.66 to 0.58%).
Conclusions
Despite current efforts to reduce disparity in stroke care, ICH patients hospitalized in rural hospitals had two times the odds of dying compared to those in urban hospitals. In addition, the ICH mortality gap between rural and urban centers is increasing. Further studies are needed to identify and reverse the causes of this disparity.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-020-00950-2</identifier><identifier>PMID: 32232726</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aphasia - physiopathology ; Cerebral Hemorrhage - mortality ; Cerebral Hemorrhage - physiopathology ; Cerebral Hemorrhage - therapy ; Comorbidity ; Craniotomy ; Critical Care Medicine ; Deglutition Disorders - physiopathology ; Female ; Healthcare Disparities ; Hospital Bed Capacity ; Hospital Mortality - trends ; Hospitals, Rural ; Hospitals, Urban ; Humans ; Hydrocephalus - physiopathology ; Intensive ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Neurology ; Original Work ; Palliative care ; Respiration, Artificial ; Risk Factors ; Stroke ; United States ; Young Adult</subject><ispartof>Neurocritical care, 2020-06, Vol.32 (3), p.715-724</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-da6e4b2b7bba9f3a5e698172af5e33a88d0254d6b3aee3b53af11eb177d6a1c73</citedby><cites>FETCH-LOGICAL-c474t-da6e4b2b7bba9f3a5e698172af5e33a88d0254d6b3aee3b53af11eb177d6a1c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-020-00950-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919713122?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,21388,21389,27924,27925,33530,33531,33744,33745,41488,42557,43659,43805,51319,64385,64387,64389,72341</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32232726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Otite, Fadar Oliver</creatorcontrib><creatorcontrib>Akano, Emmanuel Oladele</creatorcontrib><creatorcontrib>Akintoye, Emmanuel</creatorcontrib><creatorcontrib>Khandelwal, Priyank</creatorcontrib><creatorcontrib>Malik, Amer M.</creatorcontrib><creatorcontrib>Chaturvedi, Seemant</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><title>Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Objectives
To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA.
Methods
We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariable-adjusted models to compare odds of mortality between rural and urban hospitals. Joinpoint regression was used to evaluate trends in age- and sex-adjusted mortality in rural and urban hospitals over time.
Results
From 2004 to 2014, 5.8% of ICH patients were admitted in rural hospitals. Rural patients were older (mean [SE] 76.0 [0.44] years vs. 68.8 [0.11] years in urban), more likely to be white and have Medicare insurance. Age- and sex-adjusted mortality was greater in rural hospitals (32.2%) compared to urban patients (26.5%) (
p
value < 0.001). After multivariable adjustment, patients hospitalized in rural hospitals had two times the odds of in-hospital death compared to patients in urban hospitals (OR 2.07, 95% CI 1.77–2.41.
p
value < 0.001). After joinpoint regression, mortality declined in urban hospitals by an average of 2.8% per year (average annual percentage change, [AAPC] − 2.8%, 95% CI − 3.7 to − 1.8%), but rates in rural hospitals remained unchanged (AAPC − 0.54%, 95% CI − 1.66 to 0.58%).
Conclusions
Despite current efforts to reduce disparity in stroke care, ICH patients hospitalized in rural hospitals had two times the odds of dying compared to those in urban hospitals. In addition, the ICH mortality gap between rural and urban centers is increasing. Further studies are needed to identify and reverse the causes of this disparity.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aphasia - physiopathology</subject><subject>Cerebral Hemorrhage - mortality</subject><subject>Cerebral Hemorrhage - physiopathology</subject><subject>Cerebral Hemorrhage - therapy</subject><subject>Comorbidity</subject><subject>Craniotomy</subject><subject>Critical Care Medicine</subject><subject>Deglutition Disorders - physiopathology</subject><subject>Female</subject><subject>Healthcare Disparities</subject><subject>Hospital Bed Capacity</subject><subject>Hospital Mortality - trends</subject><subject>Hospitals, Rural</subject><subject>Hospitals, Urban</subject><subject>Humans</subject><subject>Hydrocephalus - physiopathology</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Original Work</subject><subject>Palliative care</subject><subject>Respiration, Artificial</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>United States</subject><subject>Young Adult</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi0EouXAC7BAltiwCfiSxAkLpKpQeqRyEeWsrXEyOcdVYqd2gtQdEo_AG_IkOD2lXBasPNJ883v--Ql5zNlzzph6EblgosqYYBljdcEycYcc8qIoM1aX_O5S5zwraykPyIMYLxgTqlbFfXIghZBCifKQfPs0B-h_fP2-CQYcfW3jCMFOFiO1jq7dFKDBgCZB9BQHH8IOtkjf-TBBb6erhZp2SDfnRy_px4C9HayDcEVPrGut20baBT9cI-9hst4lnbUbU4luoucwjD0-JPc66CM-unlXZHPy5vPxaXb24e36-Ogsa3KVT1kLJeZGGGUM1J2EAsu64kpAV6CUUFUtE0XelkYCojSFhI5zNFyptgTeKLkir_a642wGbBtc3PV6DHZIG2sPVv_dcXant_6LVulcvMqTwLMbgeAvZ4yTHmxssO_BoZ-jFrIq0llTGAl9-g964eeQ3Ceq5rXikifRFRF7qgk-xoDd7TKc6SVjvc9Yp4z1dcZ6GXryp43bkV-hJkDugZhabovh99__kf0JT5e1wQ</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Otite, Fadar Oliver</creator><creator>Akano, Emmanuel Oladele</creator><creator>Akintoye, Emmanuel</creator><creator>Khandelwal, Priyank</creator><creator>Malik, Amer M.</creator><creator>Chaturvedi, Seemant</creator><creator>Rosand, Jonathan</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200601</creationdate><title>Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample</title><author>Otite, Fadar Oliver ; Akano, Emmanuel Oladele ; Akintoye, Emmanuel ; Khandelwal, Priyank ; Malik, Amer M. ; Chaturvedi, Seemant ; Rosand, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-da6e4b2b7bba9f3a5e698172af5e33a88d0254d6b3aee3b53af11eb177d6a1c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aphasia - physiopathology</topic><topic>Cerebral Hemorrhage - mortality</topic><topic>Cerebral Hemorrhage - physiopathology</topic><topic>Cerebral Hemorrhage - therapy</topic><topic>Comorbidity</topic><topic>Craniotomy</topic><topic>Critical Care Medicine</topic><topic>Deglutition Disorders - physiopathology</topic><topic>Female</topic><topic>Healthcare Disparities</topic><topic>Hospital Bed Capacity</topic><topic>Hospital Mortality - trends</topic><topic>Hospitals, Rural</topic><topic>Hospitals, Urban</topic><topic>Humans</topic><topic>Hydrocephalus - physiopathology</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Original Work</topic><topic>Palliative care</topic><topic>Respiration, Artificial</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Otite, Fadar Oliver</creatorcontrib><creatorcontrib>Akano, Emmanuel Oladele</creatorcontrib><creatorcontrib>Akintoye, Emmanuel</creatorcontrib><creatorcontrib>Khandelwal, Priyank</creatorcontrib><creatorcontrib>Malik, Amer M.</creatorcontrib><creatorcontrib>Chaturvedi, Seemant</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Otite, Fadar Oliver</au><au>Akano, Emmanuel Oladele</au><au>Akintoye, Emmanuel</au><au>Khandelwal, Priyank</au><au>Malik, Amer M.</au><au>Chaturvedi, Seemant</au><au>Rosand, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>32</volume><issue>3</issue><spage>715</spage><epage>724</epage><pages>715-724</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Objectives
To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA.
Methods
We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariable-adjusted models to compare odds of mortality between rural and urban hospitals. Joinpoint regression was used to evaluate trends in age- and sex-adjusted mortality in rural and urban hospitals over time.
Results
From 2004 to 2014, 5.8% of ICH patients were admitted in rural hospitals. Rural patients were older (mean [SE] 76.0 [0.44] years vs. 68.8 [0.11] years in urban), more likely to be white and have Medicare insurance. Age- and sex-adjusted mortality was greater in rural hospitals (32.2%) compared to urban patients (26.5%) (
p
value < 0.001). After multivariable adjustment, patients hospitalized in rural hospitals had two times the odds of in-hospital death compared to patients in urban hospitals (OR 2.07, 95% CI 1.77–2.41.
p
value < 0.001). After joinpoint regression, mortality declined in urban hospitals by an average of 2.8% per year (average annual percentage change, [AAPC] − 2.8%, 95% CI − 3.7 to − 1.8%), but rates in rural hospitals remained unchanged (AAPC − 0.54%, 95% CI − 1.66 to 0.58%).
Conclusions
Despite current efforts to reduce disparity in stroke care, ICH patients hospitalized in rural hospitals had two times the odds of dying compared to those in urban hospitals. In addition, the ICH mortality gap between rural and urban centers is increasing. Further studies are needed to identify and reverse the causes of this disparity.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32232726</pmid><doi>10.1007/s12028-020-00950-2</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; ProQuest Central (Alumni Edition); ProQuest Central UK/Ireland; SpringerLink Journals - AutoHoldings; ProQuest Central |
| subjects | Adolescent Adult Aged Aged, 80 and over Aphasia - physiopathology Cerebral Hemorrhage - mortality Cerebral Hemorrhage - physiopathology Cerebral Hemorrhage - therapy Comorbidity Craniotomy Critical Care Medicine Deglutition Disorders - physiopathology Female Healthcare Disparities Hospital Bed Capacity Hospital Mortality - trends Hospitals, Rural Hospitals, Urban Humans Hydrocephalus - physiopathology Intensive Internal Medicine Male Medicine Medicine & Public Health Middle Aged Mortality Neurology Original Work Palliative care Respiration, Artificial Risk Factors Stroke United States Young Adult |
| title | Rural–Urban Disparities in Intracerebral Hemorrhage Mortality in the USA: Preliminary Findings from the National Inpatient Sample |
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