Racial differences in demographics, acute complications, and outcomes in patients with subarachnoid hemorrhage: a large patient series.
OBJECTIVE
Few studies have focused on the impact of racial differences in demographics, clinical characteristics, acute complications, and outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to examine this issue.


METHODS
The authors evaluated prospectively collected data on 1711 adult patients with aneurysmal SAH who were entered into two randomized, double-blind, placebo-controlled trials conducted at neurosurgical centers in North America between 1991 and 1997. Admission characteristics, treatment modalities, in-hospital complications, and 3-month outcomes assessed by application of the Glasgow Outcome Scale were compared using the chi-square test, a t-test, the Wilcoxon rank-sum test, and multiple logistic regressions based on a significance level of 0.05 in 241 African-American, 1342 Caucasian, and 128 other racial minority patients. Caucasian patients were significantly older than patients of other races (p < 0.0001). African-American patients more frequently had a history of hypertension (p < 0.0001) and an elevated blood pressure at the time of admission (p < 0.0001). African-Americans and other racial minorities were more likely to have internal carotid artery aneurysms and Caucasians were more likely to have posterior circulation aneurysms (p = 0.0002). Rates of in-hospital complications were not significantly different except that pulmonary edema occurred more commonly in Caucasians (p = 0.036). After an adjustment was made for significant admission characteristics, the 3-month outcome was not significantly different among the races.


CONCLUSIONS
Race was not found to be a prognostic factor for outcome after aneurysmal SAH. The higher SAH mortality rate previously observed in African-American patients is likely a result of a higher incidence of SAH in this group. These findings highlight the importance of primary prevention programs aimed at modifying risk factors for SAH.
Rosen
David
D
Section of Neurosurgery (Department of Surgery), Neurocritical Care and Acute Stroke Program, and Department of Health Studies, Pritzker School of Medicine, University of Chicago, Illinois 60637, USA.
Novakovic
Roberta
R
Goldenberg
Fernando D
FD
Huo
Dezheng
D
Baldwin
Maria E
ME
Frank
Jeffrey I
JI
Rosengart
Axel J
AJ
Macdonald
R Loch
RL
D000328:Adult; D001741:Black or African American; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010343:Patient Admission; D011281:Pregnatrienes / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000208:ethnology* / Q000628:therapy; D016896:Treatment Outcome; D044465:White People
D018696:Neuroprotective Agents; D011281:Pregnatrienes; C053355:tirilazad