Spontaneous Intracerebral Hemorrhage in the Elderly Population

Aims: Spontaneous intracerebral hemorrhage (ICH) is a devastating disease that disproportionately affects the geriatric population. Clinical trials for ICH exclude patients older than 80, limiting our knowledge of the natural history of this condition in this age group. We aimed to characterize this specific ICH population and evaluate how risk factors for in-hospital mortality vary by age group.

Methods: This is a cross-sectional study using administrative claims data from hospitals in California between 2005 and 2011. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to (1) identify patients admitted with primary, nontraumatic ICH; (2) ascertain relevant comorbidities; and (3) ascertain in-hospital death. We stratified ICH cases according to age (< 80 and ≥ 80) and implemented univariate tests to compare age groups. For each age group, we utilized multivariate logistic regression to model the odds of in-hospital mortality after accounting for potential confounders.

Results: Sixty-one thousand one-hundred ninety ICH cases were admitted during the study period. Of these, 17,471 (29%) cases were ≥ 80 years old. In-hospital mortality was 27% overall, 31% for those aged ≥ 80, and 25% for those <80 (p < 0.001). The elderly ICH population had more females, Caucasians, Medicare, hypertension, heart failure, chronic lung disease, and malignancy, and less smokers, hypercoagulability, and diabetes (all p < 0.001). Atrial fibrillation (odds ratio [OR] 1.27, confidence interval [CI] 1.19–1.35, p < 0.001), intubation (OR 14.31, CI 13.63–15.00, p < 0.001), and race (OR 0.91, CI 0.90–0.93, p < 0.001) were independently associated with mortality in both age cohorts. Chronic kidney disease (OR 1.41, CI 1.28–1.55, p < 0.001), malignancy (OR 1.65, CI 1.52–1.78, p < 0.001), and female sex (OR 1.12, CI 1.06–1.18, p < 0.001) were risk factors for death in the < 80 cohort. Heart failure (OR 1.14, CI 1.01–1.27, p = 0.03) and type of insurance (OR 1.06, CI 1.02–1.12, p = 0.009) were independent risk factors for mortality in the ≥80 cohort.

Conclusions: In California from 2005 to 2011, the elderly (≥ 80) population comprised 29% of admissions for ICH. Mortality was higher in this age group. Determinants of in-hospital death vary by age group. Further studies are needed to better characterize ICH in the elderly and understand their response to potential therapeutic interventions.

No conflict of interest has been declared by the author(s).