动脉瘤性蛛网膜下腔出血(aSAH)与高死亡率相关。在描述人口统计学全球差异的文献中存在显著差距,管理,aSAH患者的结局。我们旨在进行系统评价和荟萃分析,以评估aSAH表达和管理方面的全球差异。PubMed和Embase数据库从最早的记录查询到2022年11月的aSAH文献。介绍,人口统计,合并症,治疗方法,并收集结果数据。未报告aSAH特异性患者管理和结果的文章被排除。计算合并加权患病率。报告了随机效应模型率。筛选后,包括代表10,553名患者的33篇文章。Fisher3级或4级aSAH在高收入和低收入国家的患病率(HIC和LIC),分别,分别为79.8%(P<0.01)和84.1(P<0.01)。男性aSAH患者在HIC和LIC中的患病率,分别,分别为35.8%(P<0.01)和45.0%(P<0.01)。ASAH患者的HIC和LIC治疗患病率分别为99.5%(P<0.01)和99.4%(P=0.16),分别。在HIC,aSAH患者中35%(P<0.01)的动脉瘤接受了盘绕治疗。无LIC报告aSAH治疗的盘绕;LIC仅报告手术夹闭率,总患病率为92.4%(P<0.01)。HIC为65.6%(P<0.01)。在这个分析中,我们发现HIC和LIC中高级别SAH出血的发生率相似,但LIC中缺乏血管内弹簧圈栓塞治疗.需要进一步的研究和讨论来确定治疗差异的原因和可干预的社会因素,以改善全球aSAH结果。
OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing
global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic
review and meta-analysis to assess
global disparities in aSAH presentation and management.
METHODS: PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported.
RESULTS: After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC.
CONCLUSIONS: In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.