343 Regional Variability in the Management of Aneurysmal Subarachnoid Hemorrhage for Black Patients: An Analysis of Treatment Patterns, Outcomes, and End-of-life Care.

INTRODUCTION: Disparities in the care of Black Americans with aneurysmal subarachnoid hemorrhage (aSAH) have been described. However, regional variations for Black patients with aSAH have yet to be delineated, particularly in end-of-life care. METHODS: We analyzed aSAH data from the Nationwide Inpatient Sample (NIS) from 2016-2020. Controlling for covariates, multivariate logistic regression models were used to assess U.S. Census region differences between Black and White patients in treatment, adverse outcomes, mortality, use of palliative care as well as do not resuscitate (DNR) and of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, blood transfusion). RESULTS: Black patients in the East-North Central (ENC) division were less likely to have inpatient morality following aSAH (OR 0.68, 95% CI 055 – 0.83, p <0.001), yet more likely to have tracheostomy (OR 1.83, 95% CI 1.39 - 2.49, p < 0.001) and gastrostomy (OR 1.66, 95% CI 1.31 - 2.11, p < 0.001) tube placement than the national average. Furthermore, Black patients in the ENC were less likely to have palliative care (OR 0.42, 95% CI 0.22 - 0.80, p = 0.008) This trend continued in the West South-Central (WSC) division for tracheostomy (OR 1.86, 95% CI 1.29 - 2.66, p = 0.001), gastrostomy (OR 1.95, 95% CI 1.44 - 2.63, p < 0.001), and palliative care (OR .67, 95% CI 0.51 - 0.87, p = 0.003). CONCLUSIONS: Geographic variations exist in the treatment of Black patients with aSAH. Nationally and regionally Black patients have lower mortality rates than White patients, due in part to disparities in end-of-life care. Black patients receive more life-sustaining interventions, and less palliative care and DNR; this is most evident in the ENC and WSC regions. Paradoxically, regions with more Black residents fare worse.