Aggressiveness of care following intracerebral hemorrhage in women and men

Rahul Guha, Amelia Boehme, Stacie L. Demel, Janet J. Li, Xuemei Cai, Michael L. James, Sebastian Koch, Carl D. Langefeld, Charles J. Moomaw, Jennifer Osborne, Padmini Sekar, Kevin N. Sheth, E. Woodrich, Bradford B. Worrall, Daniel Woo, Seemant Chaturvedi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0.1 in univariate analyses and backward elimination to retain those that were significant (p < 0.05). Results: Women were older on average (65.0 vs 59.9, p < 0.0001), and higher proportions of women had previous stroke (24.1% vs 19.3%, p = 0.002), had dementia (6.1% vs 3.4%, p = 0.0007), lived alone (23.1% vs 18.0%, p = 0.0005), and took anticoagulants (12.8% vs 10.1% p = 0.02), compared with men. Men had higher rates of alcohol and cocaine use. After adjusting for age, hematoma volume, and ICH location, there was no difference in rates of surgical treatment by sex (odds ratio [OR] 0.93 for men vs women, 95% confidence interval [CI] 0.68-1.28, p = 0.67), and there was no difference in DNR/comfort care decisions after adjustment for ICH score, prior stroke, and dementia (OR 0.96, CI 0.77-1.22, p = 0.76). Conclusions: After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.

Original languageEnglish (US)
Pages (from-to)349-354
Number of pages6
JournalNeurology
Volume89
Issue number4
DOIs
StatePublished - Jul 25 2017

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Cerebral Hemorrhage
Comorbidity
Palliative Care
Dementia
Stroke
Odds Ratio
Resuscitation Orders
Confidence Intervals
Sexism
Sex Ratio
Cocaine
Hematoma
Anticoagulants
Case-Control Studies
Multivariate Analysis
Alcohols
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Aggressiveness of care following intracerebral hemorrhage in women and men. / Guha, Rahul; Boehme, Amelia; Demel, Stacie L.; Li, Janet J.; Cai, Xuemei; James, Michael L.; Koch, Sebastian; Langefeld, Carl D.; Moomaw, Charles J.; Osborne, Jennifer; Sekar, Padmini; Sheth, Kevin N.; Woodrich, E.; Worrall, Bradford B.; Woo, Daniel; Chaturvedi, Seemant.

In: Neurology, Vol. 89, No. 4, 25.07.2017, p. 349-354.

Research output: Contribution to journalArticle

Guha, R, Boehme, A, Demel, SL, Li, JJ, Cai, X, James, ML, Koch, S, Langefeld, CD, Moomaw, CJ, Osborne, J, Sekar, P, Sheth, KN, Woodrich, E, Worrall, BB, Woo, D & Chaturvedi, S 2017, 'Aggressiveness of care following intracerebral hemorrhage in women and men', Neurology, vol. 89, no. 4, pp. 349-354. https://doi.org/10.1212/WNL.0000000000004143
Guha R, Boehme A, Demel SL, Li JJ, Cai X, James ML et al. Aggressiveness of care following intracerebral hemorrhage in women and men. Neurology. 2017 Jul 25;89(4):349-354. https://doi.org/10.1212/WNL.0000000000004143
Guha, Rahul ; Boehme, Amelia ; Demel, Stacie L. ; Li, Janet J. ; Cai, Xuemei ; James, Michael L. ; Koch, Sebastian ; Langefeld, Carl D. ; Moomaw, Charles J. ; Osborne, Jennifer ; Sekar, Padmini ; Sheth, Kevin N. ; Woodrich, E. ; Worrall, Bradford B. ; Woo, Daniel ; Chaturvedi, Seemant. / Aggressiveness of care following intracerebral hemorrhage in women and men. In: Neurology. 2017 ; Vol. 89, No. 4. pp. 349-354.
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abstract = "Objective: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0.1 in univariate analyses and backward elimination to retain those that were significant (p < 0.05). Results: Women were older on average (65.0 vs 59.9, p < 0.0001), and higher proportions of women had previous stroke (24.1{\%} vs 19.3{\%}, p = 0.002), had dementia (6.1{\%} vs 3.4{\%}, p = 0.0007), lived alone (23.1{\%} vs 18.0{\%}, p = 0.0005), and took anticoagulants (12.8{\%} vs 10.1{\%} p = 0.02), compared with men. Men had higher rates of alcohol and cocaine use. After adjusting for age, hematoma volume, and ICH location, there was no difference in rates of surgical treatment by sex (odds ratio [OR] 0.93 for men vs women, 95{\%} confidence interval [CI] 0.68-1.28, p = 0.67), and there was no difference in DNR/comfort care decisions after adjustment for ICH score, prior stroke, and dementia (OR 0.96, CI 0.77-1.22, p = 0.76). Conclusions: After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.",
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AU - Guha, Rahul

AU - Boehme, Amelia

AU - Demel, Stacie L.

AU - Li, Janet J.

AU - Cai, Xuemei

AU - James, Michael L.

AU - Koch, Sebastian

AU - Langefeld, Carl D.

AU - Moomaw, Charles J.

AU - Osborne, Jennifer

AU - Sekar, Padmini

AU - Sheth, Kevin N.

AU - Woodrich, E.

AU - Worrall, Bradford B.

AU - Woo, Daniel

AU - Chaturvedi, Seemant

PY - 2017/7/25

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N2 - Objective: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0.1 in univariate analyses and backward elimination to retain those that were significant (p < 0.05). Results: Women were older on average (65.0 vs 59.9, p < 0.0001), and higher proportions of women had previous stroke (24.1% vs 19.3%, p = 0.002), had dementia (6.1% vs 3.4%, p = 0.0007), lived alone (23.1% vs 18.0%, p = 0.0005), and took anticoagulants (12.8% vs 10.1% p = 0.02), compared with men. Men had higher rates of alcohol and cocaine use. After adjusting for age, hematoma volume, and ICH location, there was no difference in rates of surgical treatment by sex (odds ratio [OR] 0.93 for men vs women, 95% confidence interval [CI] 0.68-1.28, p = 0.67), and there was no difference in DNR/comfort care decisions after adjustment for ICH score, prior stroke, and dementia (OR 0.96, CI 0.77-1.22, p = 0.76). Conclusions: After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.

AB - Objective: To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0.1 in univariate analyses and backward elimination to retain those that were significant (p < 0.05). Results: Women were older on average (65.0 vs 59.9, p < 0.0001), and higher proportions of women had previous stroke (24.1% vs 19.3%, p = 0.002), had dementia (6.1% vs 3.4%, p = 0.0007), lived alone (23.1% vs 18.0%, p = 0.0005), and took anticoagulants (12.8% vs 10.1% p = 0.02), compared with men. Men had higher rates of alcohol and cocaine use. After adjusting for age, hematoma volume, and ICH location, there was no difference in rates of surgical treatment by sex (odds ratio [OR] 0.93 for men vs women, 95% confidence interval [CI] 0.68-1.28, p = 0.67), and there was no difference in DNR/comfort care decisions after adjustment for ICH score, prior stroke, and dementia (OR 0.96, CI 0.77-1.22, p = 0.76). Conclusions: After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.

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