Socioeconomic Disparities and Challenges in Urban Detroit: Predicting Loss to Follow-Up After Treatment for Intracranial Aneurysms

Intracranial aneurysmal subarachnoid hemorrhages (aSAH) can cause debilitating acute and chronic symptoms, and loss-to-follow-up (LTF) is a prominent issue affecting longitudinal care. Higher rates of follow-up have been correlated with better outcomes, and this study sought to identify disparities in the urban Detroit patient population and factors that may predispose patients to not receiving post-hospitalization care. This retrospective study identified 352 patients with ruptured aSAH from 2013-2024 treated within a metro-Detroit hospital system. LTF was defined as lack of follow-up imaging >500 days post-discharge. Patient demographics and socioeconomic variables were reviewed, and Chi-square and Fisher’s tests were utilized to determine whether these variables were associated with LTF. LASSO analysis was performed to determine the impact of these variables on LTF. 287 aSAH patients were analyzed (71% female, mean age 56 years). 50.4% identified within a minority group, with a mean State Decile of 6.5 +/- 3.1 and National Percentile of 72.8 +/- 24.2. Nearly half of patients were LTF (n=137, 48%). The median distance from the hospital was <25 miles. Patients LTF were more likely to be unemployed, single, have a prolonged hospital stay, mRS score >2, and discharged to SNF or LTAC (all p<0.05). Among predictors, payment source had the greatest influence on LTF status (β=2.219). This study highlights the diversity of the treated aSAH population, with the average patient representing a lower-to-middle-income class demographic at state and national levels. Key predictors of LTF are multifactorial and include payment source, employment status, discharge disposition, and functional status at discharge.