Women Fare Worse Than Men After Acute Nontraumatic Intracerebral Hemorrhage
Rohan Mangal1, Alexandra Craen2, Tej Stead3, Latha Ganti2
1Johns Hopkins University, 2University of Central Florida College of Medicine, 3Brown University
Objective:
To study gender differences in ultimate discharge destination (home, hospice, death) after acute non-traumatic intracerebral hemorrhage (anICH).
Background:
Nontraumatic intracranial hemorrhages (ICH) are serious cerebrovascular events with high morbidity and mortality. They occur in about two million people a year worldwide, but there is little data on the differences in outcomes by gender.
Design/Methods:

IRB-exempt observational cohort study of de-identified patient data spanning a two-year period and 176 hospital emergency departments.

Results:

The cohort (n = 8069) was 48% female, median age 71 for women and 65 for men. Women had 30% increased odds of death or in hospice (OR 1.304, 95% CI: 1.183-1.440), which held statistical significance (P < 0.0001). They also had 24% decreased odds of being discharged home (OR: 0.7619, 95% CI: 0.6839-0.8490, P<0.0001).

Age was a contributing factor to patients ending up dead or in hospice (< 0.0001). For every one-year increase in age, there was a corresponding 2.4% increased odds of death/hospice (OR: 1.024, 95% CI: 1.021-1.028). Both age (P < 0.0001) and gender (P = 0.0069) retained statistical significance under a multivariate logistic regression model (R2 = 0.220).

The median length of stay was three days (IQR: 1-8) for women and four days (IQR: 1-9) for men. The trend between age and length of stay was negative; younger patients had a higher length of stay, likely because older patients tended to die sooner. Both age (< 0.0001) and gender (= 0.0002) were significant under this regression model (R2 = 0.0156).

Conclusions:

Even after controlling for age, women were significantly more likely to die or be discharged to hospice. A combination of physiological, social, and geographical components may play a role in differences in outcomes by gender, making it difficult to determine a specific target for improving outcomes in such a devastating diagnosis.