Title : Disparities in mortality, hospitalization costs, and length of stay after intracerebral hemorrhage: Cross-sectional analysis of the 2022 U.S. national inpatient sample
Abstract:
Intracerebral hemorrhage (ICH) is among the most devastating forms of stroke, carrying high mortality, prolonged hospitalization, and substantial financial burden. Whether disparities in outcomes across racial, insurance, and socioeconomic groups persist in the era of contemporary stroke care remains unclear, and addressing this gap is critical for advancing equitable neurocritical care. A cross-sectional study was conducted using the 2022 National Inpatient Sample (NIS), the largest all-payer U.S. inpatient database.
Adult discharges with a primary diagnosis of ICH (ICD-10: I61.x) were included. Survey weights were applied to generate nationally representative estimates. The primary outcome was in-hospital mortality; secondary outcomes included length of stay (LOS) and total hospital charges. Predictors of interest were race, primary payer, and ZIP-code income quartile, with adjustment for age and sex. Multivariable regression models were used for mortality, LOS, and charges. A weighted national estimate of 78,685 ICH hospitalizations was identified in 2022. Overall, in-hospital mortality was 20.2%. Mean LOS was 9.9 days, and mean hospital charges exceeded $160,000. After adjustment, mortality risk varied significantly across subgroups. Black (18%) and Hispanic (19%) patients had lower adjusted mortality compared with White patients (20%), while Asian/Pacific Islander (27%) and Native American (24%) patients had markedly higher mortality. Patients with Medicaid or no insurance experienced higher odds of death relative to privately insured individuals. Disparities in resource use paralleled mortality patterns: LOS and charges were significantly greater among racial and payer subgroups, further stratified by income quartile. This study is the first to use the most recent national data to evaluate contemporary disparities in ICH outcomes. Despite advances in stroke systems of care, significant inequities persist across race, insurance, and socioeconomic context. These findings underscore the urgent need for equity-driven interventions to reduce mortality and mitigate resource burden in acute stroke care.
