Researchers led by Dr. Loch Macdonald, a neurosurgeon at St. Michael's Hospital in Toronto, said they found U.S. patients in the top 25 percent of neighborhood income have 13 percent less risk of dying from subarachnoid hemorrhage than those in the bottom quarter.
"Insurance status has been shown to significantly impact outcomes for patients with subarachnoid hemorrhage, with worse outcomes more likely to occur among patients who are inadequately insured," Macdonald said.
"Better insured patients are more likely to live in wealthy neighborhoods and have better access to timely, high-quality specialized care, which has been shown to be critical to improved outcomes after subarachnoid hemorrhage."
Macdonald said subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissue that covers the brain, an area called the subarachnoid space. It affects 10 in 100,000 people in North America each year, or about 40,000 cases a year. About one-quarter of these patients die within two weeks of hospital admission and a similar number are discharged with disabilities that may require prolonged institutional care.
The study used administrative databases to collect information on 31,631 U.S. patients and 16,531 Canadian patients. Socio-economic status was based on estimated median household income according to zip code or postal code. The average age of patients in both countries was 58.
U.S. patients living in the lowest income neighborhoods were less likely than those in wealthy neighborhoods to be Caucasians -- 52 percent vs. 70 percent -- and were more likely to be African-American or Hispanic.
Low-income patients were most likely to be seen in hospitals in the southern United States, to be on Medicaid or pay the bills themselves, and to have more pre-existing medical conditions.
Ninety-one percent of U.S. patients received urgent or emergency admission compared with 83 percent of Canadian counterparts, but 40 percent of U.S. patients had more co-morbidities, or had additional health issues compared with 25 percent of Canadians.
But the researchers said none of those factors explained the discrepancy in survival rates among U.S. patients.
The study, published in the journal Stroke, provides some evidence to support the concept that access to healthcare for low-income patients, including prevention and management of related conditions, is better in a public healthcare system such as Canada than a private healthcare system such as the United States.
"It is possible Canada's more inclusive publicly funded health insurance coverage facilitated a relatively better access to treatment for co-morbid conditions -- other illnesses -- and improved chances of better outcomes after subarachnoid hemorrhage among lower socio-economic groups," Macdonald said.
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