To test the association of socioeconomic status (SES) with outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH).

The relationship between SES and outcomes in aSAH patients has not been well explored. We aimed to investigate the impact of SES on functional and psychological outcomes, as well as in-hospital mortality.

A retrospective study was performed on a prospectively collected cohort of aSAH patients who were admitted to an academic center from 2016 to 2023. The most recent publicly available data on median household income by zip code areas (5-year estimates for 2021) was taken from the US census. Low SES was defined as using Medicaid/having no insurance or living in a zip code with the lowest 20 percentile household income. We used multivariate logistic regression analysis to assess the association between SES and outcomes.

We included 404 patients in the final analysis, mean age 58 years (SD 13.7), 65% female, 70% white, and 11% low SES. There was no association between low SES and poor functional (defined as 90-day modified Rankin Scale 3-6) or psychological (presence of anxiety or depression at discharge) outcomes when adjusted for other predictors. However, low SES was associated with lower in-hospital mortality (odds ratio 0.29, 95% CI 0.09-0.88; p=0.03) when adjusted for age, race, ethnicity, baseline modified Rankin Scale, Hunt and Hess grade and modified Fisher score.

Although low SES does not appear to be an independent predictor of poor outcomes in aSAH patients in this single center study, it was associated with lower in-hospital mortality. This raises the possibility that patients with low SES, independent of their racial/ethnic background, are less likely to undergo withdrawal from life-sustaining treatment, a common cause of in-hospital mortality in critically ill patients. Future studies are need to confirm this hypothesis.