Preliminary Analysis of the Relationship between Health Insurance Status and Spontaneous Intracerebral Hemorrhage Characteristics
Priyanka Menon1, Parth Patel1, Anthony Elengickal1, Nicole Tayag1, Srijita Nandy1, Kathryn Sinha2, Manan Shah1, Bruno Askiel1, Jonathan Crowe3, Amir Mbonde1
1Medical College of Georgia, 2Augusta University, 3UVA
Objective:
To examine the relationship between insurance status and (1) initial severity of spontaneous intracerebral hemorrhage (sICH), as measured by hematoma volume, and (2) in-hospital outcomes, including acute kidney injury (AKI), length of stay (LOS), and mortality.
Background:
Health insurance coverage influences access to acute care and outcomes following sICH. It remains unclear whether these disparities reflect differences in disease severity at presentation or hospital course. We aimed to investigate this relationship to better inform targeted strategies for patients with sICH.
Design/Methods:
We retrospectively reviewed adults admitted with sICH between January-December 2020 and October 2024-June 2025 at a Southeastern U.S. tertiary center. Demographic, clinical, and radiologic data were extracted from electronic records. Patients were grouped as insured (private, Medicare, Medicaid, VA) or uninsured. Outcomes included ICH volume, initial systolic blood pressure (SBP), LOS, AKI, and mortality. Group comparisons used independent t-tests and chi-square analyses; regression analysis for associations between sICH and outcomes was planned.
Results:
Among 147 patients (mean age 63 ± 13 years; 59% male), 68% were insured. Uninsured patients were younger (58 vs 67 years) and more likely to present with higher SBP (median 179 vs 167 mmHg) and brainstem involvement (26% vs 3%). Mean hematoma volume was similar (14.1 vs 13.7 mL). Uninsured status was associated with non-significant trends towards longer LOS (22 vs 12 days, p=0.06), higher rate of AKI (21% vs 14%, p=0.25) and higher mortality (26% vs 22%, p=0.12).
Conclusions:
In our single-center study, preliminary analyses show no statistically significant differences in hematoma volume or in-hospital outcomes by insurance status. However, trends toward higher SBP, longer hospitalization, and greater complication rates among younger and uninsured patients warrant continued investigation in larger samples. Further data collection will clarify whether insurance status independently predicts features of sICH severity and outcomes, while assessing differences among specific insurance types (private, Medicare, Medicaid, VA).
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