Race, Socioeconomic Status, and Gastrostomy after Spontaneous Intracerebral Hemorrhage

Roxanna M. Garcia*, Shyam Prabhakaran, Christopher T. Richards, Andrew M. Naidech, Matthew B. Maas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Introduction: Spontaneous intracerebral hemorrhage is a disabling form of stroke, and some patients will require nutritional interventions for dysphagia. We sought to determine if socioeconomic status indicators mediate whether minorities undergo gastrostomy tube placement. Materials and Methods: Patients with spontaneous intracerebral hemorrhage were enrolled in a single center, observational cohort study from 2010 to 2017. A socioeconomic index score was imputed using neighborhood characteristics by patients’ ZIP code, according to an established method utilizing 6 indicators of wealth/income, education, and occupation. Multivariable logistic regression models were generated and stratified by racial/ethnic groups to determine the association of socioeconomic status with gastrostomy tube placement. Results: Among 512 patients, 93 (18.2%) underwent gastrostomy tube placement. There were 245 Whites, 220 Blacks, and 47 Hispanic. Blacks underwent the highest percentage of gastrostomy placement (22.7%), and Whites had the lowest percentage (13.5%). Among patients with gastrostomy, Blacks and Hispanics had lowest median socioeconomic index (−2.1 [IQR: −3.0, .7]; .7 [IQR: −1.6, 2.9], respectively, P < .001). Increasing intracerebral hemorrhage score was correlated with higher odds of gastrostomy across all groups (P values ≤ .01) but only Hispanics had reduced adjusted odds of gastrostomy with increasing socioeconomic index (OR .56; 95% .33-.84; P = .01). Discussion: Racial/ethnic minorities had lower socioeconomic index and underwent more gastrostomy placement. Socioeconomic index was independently associated with gastrostomy only in Hispanics, in whom the odds of gastrostomy decreased with increasing socioeconomic index. Summary & Conclusion: Differences in utilization of gastrostomy were evident among minorities, and socioeconomic status may mediate this relationship among Hispanics.

Original languageEnglish (US)
Article number104567
JournalJournal of Stroke and Cerebrovascular Diseases
Volume29
Issue number2
DOIs
StatePublished - Feb 2020

Funding

Funding: Dr. Naidech receives support from Agency for Healthcare Research and Quality grant K18 HS023437. Dr. Maas receives support from National Institutes of Health grants K23 NS092975. Dr. Garcia serves as the StrokeNet Research fellow under grant U24 NS107233-01. Research reported in this publication was supported by the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • Healthcare disparities
  • intracerebral hemorrhage
  • minority health
  • socioeconomic position
  • stroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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