Variability in Intensive Care Utilization for Intracerebral Hemorrhage in the United States: Retrospective Cohort Study |
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| Affiliation: | 1. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States;2. Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States;3. Icahn School of Medicine at Mount Sinai, New York, NY, United States;1. Department of Radiology, Mayo Clinic;2. Department of Quantitative Health Sciences, Mayo Clinic;3. Department of Neurology, Mayo Clinic;4. Department of Quantitative Health Sciences, Mayo Clinic;1. Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan;2. Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8648, Japan;3. Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-Ku, Sapporo 060-8648, Japan;4. The Division of Clinical Genetics, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8638, Japan;5. Department of Molecular Genetics, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan;1. University of Iowa Carver College of Medicine, United States;2. University of Iowa, Neurology Residency, United States;3. University of Iowa, Neuroradiology Department, United States;4. University of Iowa, Neurology Department, 200 Hawkins Drive, Iowa City IA 52242, United States;5. Iowa City VA Medical Center, United States;1. Clinical Research Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Chile;2. Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;3. Department of General Emergency, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;4. Genetic and Genomic Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;5. Department of Imaging, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;6. Department of Pediatrics and Ginecology, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;7. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia |
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| Abstract: | ObjectivesThere are urban-rural geographic health disparities in intracerebral hemorrhage (ICH) outcomes. However, there is limited data regarding the relationship between intensive care (ICU) availability and ICH outcomes. We examined whether ICU availability was a significant contributor to ICH outcomes by US geographic region.Materials and methodsWe used de-identified Medicare inpatient datasets from January 2016 to December 2019 and identified all index ICH admissions, stratifying by ICU care received during the hospitalization. Distributions of teaching hospital status, quartile of ICH volume, hospital urban-rural designation, and ICU availability were obtained using chi-square test. Propensity-score matching was utilized to compare outcomes of more favorable outcome, inpatient mortality, and 30-day all-cause readmissions by ICU availability at each hospital.ResultsOut of a total of 119,891 hospitalizations for ICH, 66,306 (55.3%) received ICU-level care. Of hospitals that treated at least one ICH, 42.6% did not provide ICU level care for any ICH admission during the study period. Teaching hospitals (48.0% vs 7.0%; p<0.0001), hospitals with higher ICH case volumes (p<0.0001) and in larger metropolitan areas (p<0.0001) were more likely to have an ICU available. Propensity score-matched models showed that hospital ICU availability was associated with a lower likelihood of inpatient mortality (29.4% vs 33.7%; p=0.0016)ConclusionsRural-urban disparities in ICH outcomes are likely multifactorial, but ICU availability likely contributes to the disparity. Additional studies are necessary to elucidate other contributing mechanisms. |
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