Two decades of trends in nontraumatic intracerebral hemorrhage care: A nationwide analysis

Abstract

Purpose

This study aims to analyze the temporal trends of comorbidities, complications, and in-hospital mortality of non-traumatic intracerebral hemorrhages (ICH) over the past two decades using a nationwide inpatient sample.

Methods

The National Inpatient Sample database was screened to identify patients hospitalized with ICH from 2002 to 2022. Socio-demographic characteristics, comorbidities, complications (including ischemic stroke, seizures, aspiration pneumonia, and deep vein thrombosis/pulmonary embolism DVT/PE), neurosurgical procedures, tracheostomy, and percutaneous gastrostomy placement were reviewed. Length of hospital stay and in-hospital mortality were analyzed. Temporal trends were determined using linear logistic regression models for each predetermined variable. For dichotomous variables, the natural logarithm was calculated to achieve a harmonic linear trend. Pairwise comparison was used for subgroup analyses.

Results

A total of 467,117 patients with ICH were included in the study. From 2002 to 2022, there was a significant increase in comorbidities, including hypertension, diabetes, chronic kidney disease, obesity, and anticoagulant use, p < 0.01 for all. Patients’ age progressively decreased over time (β:-0.104, 95 %CI: −0.124–0.085, p < 0.01). Notably, a temporal increase in ischemic stroke (β:0.081, 95 %CI: 0.069–0.092, p < 0.01) and seizures (β:0.012, 95 %CI: 0.001–0.008, p < 0.01) was noted. Clot removal/decompression declined over the years (β:-0.039, 95 %CI: −0.057–0.022, p < 0.01) while EVD/VPS placement increased (β:, 95 %CI: −0.057–0.022, p < 0.01). Length of hospital stay increased yearly by 0.07 days (95 %CI: 0.04–0.08, p < 0.01). The average annual mortality rate significantly decreased by 2.43 % per year (95 %CI: −2.21 %-2.65 %, p < 0.01). In-hospital mortality rates declined more rapidly in urban areas compared to rural areas (0.99 % difference, 95 %CI: 0.5 %-1.48 %, p < 0.01). No statistical difference was observed among sex, racial or income groups; however, there was a trend toward a slower decline in in-hospital mortality among lower-income compared to higher-income groups.

Conclusion

Despite increasing patient complexity, in-hospital mortality has steadily decreased in ICH patients over the last two decades. These improvements have come at the cost of longer hospital stays. Profound inequities remain in the mortality rate in rural areas.