Scholarlink

Background <p>Low sociodemographic index (SDI) countries bear a disproportionate burden of aneurysmal subarachnoid hemorrhage (SAH) yet remain underrepresented in medical research.</p> Methods <p>A retrospective multicenter cohort of 1145 patients from tertiary centers in Brazil and the USA (2012–2024). Demographics, clinical severity (WFNS, modified Fisher scale, mFs), treatment modality, and outcomes were compared. Primary outcomes were in-hospital mortality and poor functional outcome (mRS &gt; 2); secondary outcome was hospital length of stay (LOS). Multiple imputation was used for missing at random (MAR)-type missingness; adjusted models incorporated Bonferroni correction.</p> Results <p>Mean age was 54.5 ± 14.4&#xa0;years; 73.9% female. Racial/ethnic distribution was 49.6% White, 23.5% Black, 19.5% multiracial, 1.7% Asian, 5.6% other, and 0.2% Native American. Hypertension and smoking were more prevalent among American patients, Black and White individuals, respectively. Brazilian patients underwent microsurgery more often (61.9% vs. 92% endovascular in the USA) and had markedly longer time to treatment (77.7 vs. 4.3&#xa0;h; <i>p</i> &lt; 0.0001).&#xa0;In-hospital mortality was higher in Brazil (23.4% vs. 13.4%; OR 1.98; <i>p</i> &lt; 0.0001) and remained significant after adjustment. LOS was shorter in the USA (–5.4&#xa0;days; <i>p</i> = 0.0021). Black Brazilians had worse outcomes (OR 2.3; <i>p</i> = 0.0028), while White patients trended toward lower mortality overall (OR 0.7; <i>p</i> = 0.0350). Rehabilitation access differed sharply (39.8% vs. 0.8%). Poor long-term outcome was more common in Brazil (53.2% vs. 38.8%; <i>p</i> &lt; 0.0001).</p> Conclusions <p>Although USA patients had more vascular comorbidities, Brazilian hospitals experienced substantially higher mortality and long-term disability. These differences were consistent with disparities in care delivery and resource availability—reflected by longer treatment delays, differing treatment modalities, and limited access to post-acute rehabilitation—beyond measured patient-level risk, while also underscoring the importance of primary care-based prevention in high-income settings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Bridging Continents, Closing Gaps: A Multicenter Cohort Study on Subarachnoid Hemorrhage Outcomes and Health Care Disparities

  • 期刊论文

  • 发表日期：

    2026年3月3日

查看全文
  • Natália Vasconcellos de Oliveira Souza,
  • Rohan Sharma,
  • Otavio Frederico de Toledo,
  • Ingrid Pereira Marques,
  • Fabian Föttinger,
  • Salvador F. Gutierrez-Aguirre,
  • Diego Alejandro Ortega Moreno,
  • Yvone Taube Maranho,
  • Luísa Souhami Belford Roxo,
  • Maria Julia Teixeira Barreto,
  • Lara-Velazquez Montserrat,
  • Victor H. C. Benali,
  • Eric Sauvageau,
  • Naval Neeraj,
  • Nima Amin Aghaebrahim,
  • Cassia Righy,
  • Pedro Kurtz,
  • Feres Chaddad Neto,
  • Ricardo A. Hanel,
  • Gisele Sampaio Silva,
  • William David Freeman

摘要

Background

Low sociodemographic index (SDI) countries bear a disproportionate burden of aneurysmal subarachnoid hemorrhage (SAH) yet remain underrepresented in medical research.

Methods

A retrospective multicenter cohort of 1145 patients from tertiary centers in Brazil and the USA (2012–2024). Demographics, clinical severity (WFNS, modified Fisher scale, mFs), treatment modality, and outcomes were compared. Primary outcomes were in-hospital mortality and poor functional outcome (mRS > 2); secondary outcome was hospital length of stay (LOS). Multiple imputation was used for missing at random (MAR)-type missingness; adjusted models incorporated Bonferroni correction.

Results

Mean age was 54.5 ± 14.4 years; 73.9% female. Racial/ethnic distribution was 49.6% White, 23.5% Black, 19.5% multiracial, 1.7% Asian, 5.6% other, and 0.2% Native American. Hypertension and smoking were more prevalent among American patients, Black and White individuals, respectively. Brazilian patients underwent microsurgery more often (61.9% vs. 92% endovascular in the USA) and had markedly longer time to treatment (77.7 vs. 4.3 h; p < 0.0001). In-hospital mortality was higher in Brazil (23.4% vs. 13.4%; OR 1.98; p < 0.0001) and remained significant after adjustment. LOS was shorter in the USA (–5.4 days; p = 0.0021). Black Brazilians had worse outcomes (OR 2.3; p = 0.0028), while White patients trended toward lower mortality overall (OR 0.7; p = 0.0350). Rehabilitation access differed sharply (39.8% vs. 0.8%). Poor long-term outcome was more common in Brazil (53.2% vs. 38.8%; p < 0.0001).

Conclusions

Although USA patients had more vascular comorbidities, Brazilian hospitals experienced substantially higher mortality and long-term disability. These differences were consistent with disparities in care delivery and resource availability—reflected by longer treatment delays, differing treatment modalities, and limited access to post-acute rehabilitation—beyond measured patient-level risk, while also underscoring the importance of primary care-based prevention in high-income settings.