{
  "abstract": "Background Although hemorrhagic strokes—including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)—represent a minority of stroke cases, they account for a disproportionate share of stroke-related mortality and disability. Despite advances in neurocritical care and stroke systems over the past decade, disparities in access and mortality persist across socioeconomic and geographic groups. We evaluated the influence of race, insurance status, and geographic residence on mortality among patients hospitalized with hemorrhagic stroke in a large statewide cohort.Methods We performed a retrospective analysis of inpatient admissions for ICH and aneurysmal SAH using the Florida Agency for Health Care Administration database from 2013-2024. Patients were identified using ICD-9 and ICD-10 diagnostic codes. Demographic characteristics, insurance status, geographic region, and rural versus urban residence were analyzed as proxies of social determinants of health. Comorbidities were assessed using the Elixhauser Comorbidity Index. Multivariable logistic regression models evaluated independent predictors of in-hospital mortality, and temporal mortality trends were analyzed across the study period.Results A total of 120,529 patients with hemorrhagic stroke were included (mean age 67.9 ± 15.5 years; 48.4% female). Most patients had ICH (84.3%), while 15.7% presented with SAH. Overall in-hospital mortality was 18.5%. Despite a rise in annual hemorrhagic stroke admissions from 6,690 in 2013 to 14,407 in 2023, mortality significantly declined over time (p < 0.001). However, substantial disparities persisted. After adjustment for age, sex, and comorbidities, Black patients had higher odds of in-hospital mortality than White patients (OR 1.13, 95% CI 1.07-1.20). Rural residence was also associated with increased mortality (OR 1.30, 95% CI 1.19-1.41), although only 0.4% of patients received care in rural hospitals, suggesting geographic barriers to specialized stroke care. Insurance status was a strong predictor of outcomes. Patients insured through Medicaid (OR 1.84, 95% CI 1.71-1.97) and other non-commercial payer categories (OR 1.86, 95% CI 1.75-1.97) had significantly higher mortality than Medicare beneficiaries. Regional disparities were also observed, with higher mortality in the Northwest and South regions of Florida.Conclusions In this large statewide cohort of patients with hemorrhagic stroke, in-hospital mortality declined over the past decade, but significant racial, geographic, and socioeconomic disparities persisted. Rural residence and non-commercial insurance were among the strongest predictors of mortality. These findings highlight the need to improve access to specialized stroke systems of care and develop targeted strategies to address structural inequities. Expanding hypertension control initiatives, improving transfer networks, and integrating AI-based triage tools may help reduce disparities in hemorrhagic stroke outcomes.Disclosures N. de Oliveira Souza: 1; C; Bee Foundation. A. Diíaz-Rohena: None. A. Sakusic: None. L. Galbert: None. S. Borkar: None. A. Spaulding: None. L. H. Mooney: None. M. T. Robinson: None. W. Freeman: None.Abstract E-100 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery and Neurocritical Care, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "N de Oliveira Souza"
    },
    {
      "affiliations": [
        "Neurocritical Care and Neurosurgery, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "A Diíaz-Rohena"
    },
    {
      "affiliations": [
        "Neurology, Mayo Clinic, Jacksonville, MN"
      ],
      "name": "A Sakusic"
    },
    {
      "affiliations": [
        "Neurosurgery and Neurocritical Care, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "L Galbert"
    },
    {
      "affiliations": [
        "Health Services, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "S Borkar"
    },
    {
      "affiliations": [
        "Neurosurgery and Neurocritical Care, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "A Spaulding"
    },
    {
      "affiliations": [
        "Neurosurgery and Neurocritical Care, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "LH Mooney"
    },
    {
      "affiliations": [
        "Neurology, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "MT Robinson"
    },
    {
      "affiliations": [
        "Neurosurgery and Neurocritical Care, Mayo Clinic, Jacksonville, FL"
      ],
      "name": "W Freeman"
    }
  ],
  "title": "E-100 Reducing inequalities in stroke events-hemorrhagic disparities (RISE-HD): a 10-year statewide analysis of social determinants of mortality in hemorrhagic stroke",
  "uid": "03553a33-d2de-5f9b-bf89-5889ad2eeb31"
}