Racial and Gender Disparities Among Patients Treated for Intracranial Aneurysms: A Retrospective Cohort Study in a Tertiary Public Hospital in Latin America.

BACKGROUND

Racial and gender disparities in the presentation and outcomes of intracranial aneurysms (IA) are well documented in high-income countries but remain insufficiently explored in publicly funded universal health-care systems in middle-income settings. This study examined the association between race, gender, severity at admission, and clinical outcomes among patients treated for IA in a tertiary public centre in Brazil.

METHODS

A retrospective cohort study was conducted including 693 patients treated for intracranial aneurysms between August 2018 and August 2023. Both ruptured and unruptured aneurysms were included; results are presented separately for each group. Associations between race, gender, SAH presentation, and functional outcome at discharge, assessed using the Glasgow Outcome Scale (GOS), were analysed using multivariable logistic regression models adjusted for age, comorbidities, and vascular risk factors.

RESULTS

Black and Brown patients presented with SAH more frequently than White patients (75%, 74%, and 56%, respectively; p < 0.001). Fisher grade distributions did not differ between racial groups (Fisher IV: White 62%, Brown 58%, Black 60%; p = 0.734). Black women had worse functional outcomes at discharge (53% with GOS 1-3) compared with White women (34%; p = 0.030). Race remained independently associated with SAH presentation, with higher odds among Brown (OR 2.05; 95% CI 1.33-3.16) and Black patients (OR 2.19; 95% CI 1.10-4.37).

CONCLUSIONS

Black and Brown patients were more likely to be admitted with SAH. Since Fisher grade severity did not differ between racial groups among SAH patients, the primary disparity lies in differential rates of SAH versus elective presentation, suggesting that structural determinants affect early detection pathways rather than in-hospital care. Black women represented the most vulnerable subgroup. Targeted neuroimaging screening for high-risk populations and standardisation of referral pathways may reduce the observed racial gap.