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Published online before print June 11, 2008, doi:10.1212/01.wnl.0000319690.82357.44)
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 Volume 71, Number 10, September 2, 2008
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Received December 15, 2007
Accepted May 1, 2008

Gender and ethnic differences in subarachnoid hemorrhage

S. V. Eden MD, W. J. Meurer MD, B. N. Sánchez PhD, L. D. Lisabeth PhD, MPH, M. A. Smith DrPH, MPH, D. L. Brown MD, MS, and L. B. Morgenstern MD*

From the Department of Neurosurgery (S.V.E., L.B.M.), Stroke Program (W.J.M., L.D.L., M.A.S., D.L.B., L.B.M.), Department of Neurology (L.D.L., M.A.S., D.L.B., L.B.M.), Department of Emergency Medicine (W.J.M., L.B.M.), and Department of Biostatistics (B.N.S.), University of Michigan Medical School, Ann Arbor; Semmes-Murphey Clinic (S.V.E.), Memphis, TN; and Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor.


* To whom correspondence should be addressed. E-mail: LMorgens{at}umich.edu.

Background: Mexican Americans (MAs) comprise the largest component of the largest minority group within the United States. The purpose of this study was to examine ethnic and gender differences in the epidemiology, presentation, and outcomes after subarachnoid hemorrhage (SAH) in a representative United States community. Targeted public health interventions are dependent on accurate assessments of groups at highest disease risk.

Methods: All patients with nontraumatic SAH older than 44 years were prospectively identified from January 1, 2000, to December 31, 2006, as part of the Brain Attack Surveillance In Corpus Christi project, an urban population-based study in southeast Texas. Risk ratios for cumulative SAH incidence comparing MAs with non Hispanic whites (NHWs) and women with men were calculated. Descriptive statistics for other clinical and demographic variables were computed overall, by gender, and by ethnicity.

Results: A total of 107 patients had a SAH during the time period (7-year cumulative incidence: 11/10,000); of these, 43 were NHW (40% of cases vs 53% of the population) and 64 were MA (60% of cases vs 48% of the population). The overall age-adjusted risk ratio for SAH in MAs compared with NHWs was 1.67 (95% CI: 1.13, 2.47), and in women compared to men was 1.74 (95% CI 1.16, 2.62). Overall in-hospital mortality was 32.2%. No ethnic difference was observed for discharge disability or in-hospital mortality.

Conclusions: Subarachnoid hemorrhage disproportionately affects Mexican Americans and women. Public health interventions should target these groups to reduce the impact of this severe disease.






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