# Trends in Subdural Hemorrhage-Related Mortality and Its Geodemographic Disparities Among Older Adults in the United States

## TL;DR

This study shows a steady rise in subdural hemorrhage deaths among older U.S. adults from 1999 to 2020, with significant disparities across race, ethnicity, and gender.

## Contribution

The study provides the first comprehensive analysis of SDH-related mortality trends and geodemographic disparities in older U.S. adults over two decades.

## Key findings

- The age-adjusted mortality rate for SDH increased from 17.4 to 24.6 per 100,000 individuals between 1999 and 2020.
- Non-Hispanic White individuals accounted for 84.1% of SDH-related deaths, highlighting racial disparities.
- The rate of increase in mortality slowed after 2005, but disparities across demographic groups persist.

## Abstract

Subdural hemorrhage (SDH) is a common and potentially devastating intracranial injury routinely treated in neurosurgical practice. There are limited data regarding the mortality rates associated with SDH in older adults. Quantifying SDH-related mortality is crucial, especially considering the potential financial burden from ongoing medical and rehabilitative care associated with SDH morbidity and mortality in the elderly.

Adults aged 65 years or older in the United States whose deaths attributed to SDH occurred between 1999 and 2020 were extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiological Research database. Ethnicity and race were divided into exclusive categories as Hispanic or Latino, non-Hispanic Black or African American, or non-Hispanic White. SDH-related age-adjusted mortality rate (AAMR) per 100 000 persons was determined by standardizing the crude mortality rate to the 2000 US population. Overall population and subgroup segmented regression analyses were performed using Joinpoint Regression Program.

Total of 203 295 SDH-related deaths occurred in older adults between 1999 and 2020 (AAMR 22.1 per 100 000 individuals). Of the total deaths, 110 684 (54.4%) were men, 92 611 (45.6%) women, 170 953 (84.1%) non-Hispanic White, 14 654 (7.2%) non-Hispanic Black or African American, and 9656 (4.7%) Hispanic or Latino. Overall AAMR increased from 17.4 in 1999 to 24.6 in 2020 with an average annual percent change of 1.3%; 95% CI (0.9, 1.8). The AAMR had an increase from 1999 to 2005 (annual percent change, 3.4%; 95% CI [2.0, 4.9]) followed by a slower increase from 2005 to 2020 (annual percent change, 0.5%; 95% CI [2.0, 4.9]).

There is an alarming rise in overall SDH-related mortality among the elderly population in the United States, and notable disparities in SDH outcomes across various demographic and geographic sectors continue to exist. Future health interventions aimed at SDH need to address the disparities as highlighted in this study.