Racial and Ethnic Disparities in Treatment Outcomes of Patients with Ruptured or Unruptured Intracranial Aneurysms Hind A. Beydoun 1 & May A. Beydoun 2 & Alan B. Zonderman 2 & Shaker M. Eid 1 Received: 27 June 2018 /Revised: 10 September 2018 /Accepted: 11 September 2018 # W. Montague Cobb-NMA Health Institute 2018 Abstract Objective The aim of this study is to examine how health outcomes varied by treatment selection and race/ethnicity among hospitalized US patients with ruptured or unruptured IAs. Methods A retrospective cohort study was conducted using a sample of 62,224 hospital discharges from the 2002–2012 Nationwide Inpatient Sample. Logistic regression models evaluated treatment selection as predictor of in-hospital survival (IHS: Byes,^ Bno^) and length of stay (LOS ≤ 7 days, > 7 days), overall and across racial/ethnic groups, taking hospital- and patient-level confounders into account, while stratifying by IA rupture status. Results Compared to surgical clipping, endovascular coiling was associated with better IHS, after controlling for confounders. Compared to surgical clipping, LOS ≤ 7 days was less likely in patients with combination of treatments and more likely among patients with endovascular coiling as well as balloon- or stent-assisted coiling. Observed relationships varied significantly by race and ethnicity for IHS, but not for LOS ≤ 7 days. Whereas combination of treatments were associated with worse IHS than surgical clipping among Blacks alone, endovascular coiling was associated with better IHS than surgical clipping among White and Other racial/ethnic subgroups. These relationships were for the most part consistent among patients with and without IA rupture. Conclusions Racial and ethnic subgroups of IA patients experienced differential IHS by treatment selection, irrespective of IA rupture status. Prospective cohort studies are needed to further elucidate these racial and ethnic disparities, while collecting data on IA size, location, and morphology as well as Hunt and Hess grade for ruptured IA. Keywords Aneurysm . Clipping . Coiling . Endovascular . Intracranial . Race Introduction Intracranial aneurysms (IAs) affect 5–10% of the world popu- lation [1, 2]. Unruptured IAs may grow over time and their rupture risk has a multifactorial etiology [3]. IA rupture can lead to serious complications and poor outcomes among affected patients [4]. In fact, subarachnoid hemorrhage (SAH) resulting from IA rupture has been associated with ~ 30% case-fatality rates, while rendering half of survivors functionally impaired [5, 6]. Besides observation, several treatment options are cur- rently available for patients presenting with unruptured IAs, including surgical and endovascular treatment options [6, 7]. Surgical clipping was introduced by Walter Dandy in 1937 [1, 2] and has been associated with reasonable and durable occlu- sion rates, but significant periprocedural and procedure-related complications, such as visual impairments, chronic subdural hematoma, cerebral infarction, decreased cerebral blood flow, and slight brain damage due to surgical manipulation [7, 8]. Subsequent to the introduction of the Guglielmi detachable coil in the early 1990s, endovascular coiling with or without adjunc- tive techniques such as balloon- or stent-assisted coiling (SAC) was introduced as an alternative option to surgical clipping, and was associated with lower morbidity and mortality rates as well as shorter hospital stays compared to surgical clipping [1, 2]. * Hind A. Beydoun hindb1972@gmail.com May A. Beydoun baydounm@mail.nih.gov Alan B. Zonderman zondermana@mail.nih.gov Shaker M. Eid seid1@jmhi.edu 1 Department of Medicine, Johns Hopkins School of Medicine, 9700 Skyhill Way Apt 307, Rockville, MD, USA 2 Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-018-0530-x