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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 71, Number 10, September 2, 2008 Podcast All Versions of this Article: 01.wnl.0000319690.82357.44v1 71/10/731    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Eden, S. V. Articles by Morgenstern, L. B. Search for Related Content PubMed PubMed Citation Articles by Eden, S. V. Articles by Morgenstern, L. B. Related Collections Incidence studies Natural history studies (prognosis) Risk factors in epidemiology Subarachnoid hemorrhage

Gender and ethnic differences in subarachnoid hemorrhage

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.

Address correspondence and reprint requests to Dr. Lewis B. Morgenstern, Stroke Program, University of Michigan, Cardiovascular Center Room 3194, SPC 5855, Ann Arbor, MI 48109-5855 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.

Abbreviations: BASIC = Brain Attack Surveillance in Corpus Christi; GCS = Glasgow Coma Scale; ICD = International Classification of Diseases; ICH = intracerebral hemorrhage; MA = Mexican American; mRS = modified Rankin Scale; NHW = non-Hispanic white; SAH = subarachnoid hemorrhage.

e-Pub ahead of print on June 11, 2008, at www.neurology.org.

Funded by NIH R01 NS38916.

Disclosure: The authors report no disclosures.

Received December 15, 2007. Accepted in final form May 1, 2008.