The following is a summary of “Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage,” published in the January 2024 issue of Neurology by Melmed et al.
Researchers conducted a retrospective study to investigate how Neighborhood socioeconomic status (nSES) and social determinant of health (SDoH) factors influence withdrawal of life-sustaining therapies (WLSTs) decisions and mortality in intracerebral hemorrhage (ICH) patients.
They analyzed patients with ICH at three tertiary care hospitals (January 2017 and December 2022), identified through the Get with the Guidelines Database. Information on various factors, including age, clinical severity, race/ethnicity, income, insurance, marital status, religion, mortality before discharge, and WLST, was collected from the medical records. Associations between SDoH and WLST, mortality, and poor discharge mRS were assessed using Mann-Whitney U tests and χ2 tests. Multivariable analysis was performed using backward stepwise logistic regression.
The results showed 868 ICH patients (median age 67 [IQR 55–78] years; 43% female). Black non-Hispanic, Asian, and Hispanic patients comprised 16%, 17%, and 15%, respectively. Medicare and Medicaid covered 50% and 22%, with a median (IQR) household income of $81,857 ($58,669–$122,078). Mortality was 17%, and among them, 84% had WLST. Higher-income zip codes were associated with increased WLST and mortality (P<0.01). Black non-Hispanic race linked to lower WLST and discharge mortality (P≤0.01). In multivariable analysis adjusting for age and clinical severity, high-income zip codes correlated with higher WLST (aOR 1.88; 95% CI 1.29–2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06–2.13).
They concluded that in patients with ICH, SDoH, including nSES, influenced the past decision to withdraw life-sustaining therapies.