Beyond the Haematoma: Socioeconomic Deprivation and Outcomes in Chronic Subdural Hematoma in a Single-Centre Cohort Study
- 1Department of Psychology and Neuroscience, St Georges School of Health and Medical Sciences, City St Georges, University of London, Cranmer Terrace, London, UK
Abstract
BackgroundChronic subdural hematoma (CSDH) is common and increasing in incidence. Short-term post-surgical outcomes are good, but longer term, patients experience increased morbidity and early mortality than controls and the general population. Deprivation and ethnicity affect many health conditions, but to our knowledge, this is the first UK study investigating their association with CSDH outcomes.
MethodsThis single-centre retrospective cohort study used Secondary Uses Service Admitted Patient Care Spells (SUS+ APCS) data. Adult subdural hematoma (SDH) patients admitted to St Georges Hospital, London treated with burr-hole surgery between April 2022 and April 2025 were included. Primary outcomes were initial length of stay (LoS) and days spent hospitalised in the subsequent year. Deprivation was measured using Index of Multiple Deprivation (IMD). Linear regression models estimated initial LoS and subsequent days spent hospitalised by category, adjusted for factors including age, ethnicity and comorbidities.
ResultsIn this single-centre cohort of 449 patients, IMD was not associated with initial LoS, but was significantly associated with subsequent time spent hospitalised. In a log-transformed linear regression model, the most deprived spent 4.5-times longer hospitalised during the year after CSDH than the least deprived (fold change = 4.45, 95% confidence interval (95%CI) 2.20 to 9.01).
ConclusionsHigher neighbourhood-level deprivation was associated with time spent hospitalised following CSDH. This was robust to adjustment for potential mediating factors. This is the first UK study demonstrating health inequalities in CSDH outcomes, highlighting a need for future research to gain further insights, and to improve equity of outcomes after CSDH.
What is already known on this topic?CSDH is a common sentinel health event, and risk factors include older age, alcohol misuse and taking anticoagulant or antiplatelet medications. Risk factors for poor outcomes include worse pre-morbid functional status and features of more severe CSDH. Neighbourhood-level socioeconomic deprivation is known to be associated with poor health outcomes in many conditions, including fractured neck of femur and stroke.
What this study adds?This is the first UK study to identify that neighbourhood-level deprivation is associated with poorer outcomes after CSDH. We show that greater deprivation is associated with more days hospitalised during the 12 months after CSDH, indicating that the longer-term negative impacts experienced after CSDH may be exacerbated by neighbourhood-level socioeconomic deprivation.
How this study might affect research, practice or policyFuture research should replicate these analyses in other regions, and investigate the underlying causal factors underling the inequalities in readmission for CSDH patients. Policy should focus on early intervention to mitigate risk factors for readmission, paying particular attention to those in the most deprived populations.
Related
- Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study
- Burr-Hole Intersection of Middle Meningeal Artery Branches and Recurrence in Chronic Subdural Haematoma: a Multicentre Retrospective Cohort Study
- Socioeconomic deprivation does not affect survival outcomes in patients with mantle cell lymphoma: evidence from a German nationwide study.
- Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials
- Embolization of the middle meningeal artery for non‐acute subdural hematoma
BibTeX
@misc{cook2026beyond,
title = {{Beyond the Haematoma: Socioeconomic Deprivation and Outcomes in Chronic Subdural Hematoma in a Single-Centre Cohort Study}},
author = {E. Cook and M. Fisk and C. Raggett and K. Bush and J. Boylan-Toomey and M. G. Hart},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.07.26364832},
url = {https://www.medrxiv.org/content/10.64898/2026.10.07.26364832v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Beyond the Haematoma: Socioeconomic Deprivation and Outcomes in Chronic Subdural Hematoma in a Single-Centre Cohort Study
AU - E. Cook
AU - M. Fisk
AU - C. Raggett
AU - K. Bush
AU - J. Boylan-Toomey
AU - M. G. Hart
PY - 2026
DA - 2026/10/07
PB - medRxiv
DO - 10.64898/2026.10.07.26364832
UR - https://www.medrxiv.org/content/10.64898/2026.10.07.26364832v1
AB - BackgroundChronic subdural hematoma (CSDH) is common and increasing in incidence. Short-term post-surgical outcomes are good, but longer term, patients experience increased morbidity and early mortality than controls and the general population. Deprivation and ethnicity affect many health conditions, but to our knowledge, this is the first UK study investigating their association with CSDH outcomes. MethodsThis single-centre retrospective cohort study used Secondary Uses Service Admitted Patient Care Spells (SUS+ APCS) data. Adult subdural hematoma (SDH) patients admitted to St Georges Hospital, London treated with burr-hole surgery between April 2022 and April 2025 were included. Primary outcomes were initial length of stay (LoS) and days spent hospitalised in the subsequent year. Deprivation was measured using Index of Multiple Deprivation (IMD). Linear regression models estimated initial LoS and subsequent days spent hospitalised by category, adjusted for factors including age, ethnicity and comorbidities. ResultsIn this single-centre cohort of 449 patients, IMD was not associated with initial LoS, but was significantly associated with subsequent time spent hospitalised. In a log-transformed linear regression model, the most deprived spent 4.5-times longer hospitalised during the year after CSDH than the least deprived (fold change = 4.45, 95% confidence interval (95%CI) 2.20 to 9.01). ConclusionsHigher neighbourhood-level deprivation was associated with time spent hospitalised following CSDH. This was robust to adjustment for potential mediating factors. This is the first UK study demonstrating health inequalities in CSDH outcomes, highlighting a need for future research to gain further insights, and to improve equity of outcomes after CSDH. What is already known on this topic?CSDH is a common sentinel health event, and risk factors include older age, alcohol misuse and taking anticoagulant or antiplatelet medications. Risk factors for poor outcomes include worse pre-morbid functional status and features of more severe CSDH. Neighbourhood-level socioeconomic deprivation is known to be associated with poor health outcomes in many conditions, including fractured neck of femur and stroke. What this study adds?This is the first UK study to identify that neighbourhood-level deprivation is associated with poorer outcomes after CSDH. We show that greater deprivation is associated with more days hospitalised during the 12 months after CSDH, indicating that the longer-term negative impacts experienced after CSDH may be exacerbated by neighbourhood-level socioeconomic deprivation. How this study might affect research, practice or policyFuture research should replicate these analyses in other regions, and investigate the underlying causal factors underling the inequalities in readmission for CSDH patients. Policy should focus on early intervention to mitigate risk factors for readmission, paying particular attention to those in the most deprived populations.
ER -