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<p>Cerebral amyloid angiopathy (CAA) and hypertensive (HTN) small vessel disease are causes of spontaneous intracerebral hemorrhage (ICH). We identified ICH rates in patients with all-cause mild cognitive impairment (MCI) or Alzheimer’s disease (AD), and explored feasibility of using location-based approach to differentiate CAA- and HTN-related ICH using comorbidities in electronic health records (EHRs). This administrative study combined Veterans Affairs Healthcare System plus Centers for Medicare and Medicaid Services (VAHS/CMS) databases. Patients with MCI/AD aged ≥ 50 years (2016–2023) were 1:1 matched to non-MCI/AD controls. Inpatient primary discharge International Classification of Diseases-10th Edition (ICD-10) codes identified acute ICH; anatomical location within codes classified events as likely CAA- or HTN-related ICH. Incidence rates of ICH after MCI/AD were summarized. Cluster analysis of variables related to ICH was used to describe whether data-driven groupings matched clinician-postulated classifications. The MCI/AD cohort (<i>n</i> = 747,475) and controls were aged 77.7 ± 10.1 years (96% men, 75–76% White, 87–88% non-Hispanic). Demographic- and comorbidity-adjusted rates of ICH/1000 person-years were 0.84 (overall), 1.05 (MCI/AD), and 0.68 (non-MCI/AD). Adjusted events/1000 person-years were higher in MCI/AD vs. non-MCI/AD cohorts: CAA-related ICH, 0.19 vs. 0.12 (Incidence Rate Ratio (IRR) 1.63; <i>P</i> &lt; 0.001); HTN-related ICH, 0.16 vs. 0.12 (IRR 1.35; <i>P</i> &lt; 0.001); non-specific-ICH, 0.68 vs. 0.43 (IRR 1.59; <i>P</i> &lt; 0.001). Hierarchical clustering analysis of our cohorts revealed an association of CAA-related ICH with older age, cardiovascular and rheumatic disorders, and an association of HTN-related ICH with cerebrovascular disease, hypertension and diabetes. In sum, the estimated incidence of ICH over the study period was 0.84/1000 person-years. CAA-related ICH incidence in MCI/AD was 63% greater than that in controls. Outcomes from cluster analysis are consistent with ICD-based CAA- vs. HTN-related ICH classifications. These findings support future exploration of using ICD coding-based ICH event identification in EHRs and claims databases for epidemiological studies.</p>

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Identification and characterization of intracerebral hemorrhage events in elderly veterans with alzheimer’s disease in the veterans affairs healthcare system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月19日

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  • Peter J. Morin,
  • Vanesa C. Andreu Arasa,
  • Ying Wang,
  • Joel Reisman,
  • Dan Berlowitz,
  • Wen Hu,
  • Raymond Zhang,
  • Babak Haji,
  • Ran Gao,
  • Amir Abbas Tahami Monfared,
  • Quanwu Zhang,
  • Weiming Xia

摘要

Cerebral amyloid angiopathy (CAA) and hypertensive (HTN) small vessel disease are causes of spontaneous intracerebral hemorrhage (ICH). We identified ICH rates in patients with all-cause mild cognitive impairment (MCI) or Alzheimer’s disease (AD), and explored feasibility of using location-based approach to differentiate CAA- and HTN-related ICH using comorbidities in electronic health records (EHRs). This administrative study combined Veterans Affairs Healthcare System plus Centers for Medicare and Medicaid Services (VAHS/CMS) databases. Patients with MCI/AD aged ≥ 50 years (2016–2023) were 1:1 matched to non-MCI/AD controls. Inpatient primary discharge International Classification of Diseases-10th Edition (ICD-10) codes identified acute ICH; anatomical location within codes classified events as likely CAA- or HTN-related ICH. Incidence rates of ICH after MCI/AD were summarized. Cluster analysis of variables related to ICH was used to describe whether data-driven groupings matched clinician-postulated classifications. The MCI/AD cohort (n = 747,475) and controls were aged 77.7 ± 10.1 years (96% men, 75–76% White, 87–88% non-Hispanic). Demographic- and comorbidity-adjusted rates of ICH/1000 person-years were 0.84 (overall), 1.05 (MCI/AD), and 0.68 (non-MCI/AD). Adjusted events/1000 person-years were higher in MCI/AD vs. non-MCI/AD cohorts: CAA-related ICH, 0.19 vs. 0.12 (Incidence Rate Ratio (IRR) 1.63; P < 0.001); HTN-related ICH, 0.16 vs. 0.12 (IRR 1.35; P < 0.001); non-specific-ICH, 0.68 vs. 0.43 (IRR 1.59; P < 0.001). Hierarchical clustering analysis of our cohorts revealed an association of CAA-related ICH with older age, cardiovascular and rheumatic disorders, and an association of HTN-related ICH with cerebrovascular disease, hypertension and diabetes. In sum, the estimated incidence of ICH over the study period was 0.84/1000 person-years. CAA-related ICH incidence in MCI/AD was 63% greater than that in controls. Outcomes from cluster analysis are consistent with ICD-based CAA- vs. HTN-related ICH classifications. These findings support future exploration of using ICD coding-based ICH event identification in EHRs and claims databases for epidemiological studies.