ArticleNeurocritical care2026
Bridging Continents, Closing Gaps: A Multicenter Cohort Study on Subarachnoid Hemorrhage Outcomes and Health Care Disparities.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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21 authors.
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Abstract
backgroundLow sociodemographic index (SDI) countries bear a disproportionate burden of aneurysmal subarachnoid hemorrhage (SAH) yet remain underrepresented in medical research.
methodsA retrospective multicenter cohort of 1145 patients from tertiary centers in Brazil and the USA (2012-2024). Demographics, clinical severity (WFNS, modified Fisher scale, mFs), treatment modality, and outcomes were compared. Primary outcomes were in-hospital mortality and poor functional outcome (mRS > 2); secondary outcome was hospital length of stay (LOS). Multiple imputation was used for missing at random (MAR)-type missingness; adjusted models incorporated Bonferroni correction.
resultsMean age was 54.5 ± 14.4 years; 73.9% female. Racial/ethnic distribution was 49.6% White, 23.5% Black, 19.5% multiracial, 1.7% Asian, 5.6% other, and 0.2% Native American. Hypertension and smoking were more prevalent among American patients, Black and White individuals, respectively. Brazilian patients underwent microsurgery more often (61.9% vs. 92% endovascular in the USA) and had markedly longer time to treatment (77.7 vs. 4.3 h; p < 0.0001). In-hospital mortality was higher in Brazil (23.4% vs. 13.4%; OR 1.98; p < 0.0001) and remained significant after adjustment. LOS was shorter in the USA (-5.4 days; p = 0.0021). Black Brazilians had worse outcomes (OR 2.3; p = 0.0028), while White patients trended toward lower mortality overall (OR 0.7; p = 0.0350). Rehabilitation access differed sharply (39.8% vs. 0.8%). Poor long-term outcome was more common in Brazil (53.2% vs. 38.8%; p < 0.0001).
conclusionsAlthough USA patients had more vascular comorbidities, Brazilian hospitals experienced substantially higher mortality and long-term disability. These differences were consistent with disparities in care delivery and resource availability-reflected by longer treatment delays, differing treatment modalities, and limited access to post-acute rehabilitation-beyond measured patient-level risk, while also underscoring the importance of primary care-based prevention in high-income settings.
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