Analyse du Risque de Rupture Des AnévrysMes Intracrâniens au Travers Des Déterminants Sociaux de Santé

Intracranial aneurysms (IA), the most common intracranial arterial malformation, affect approximately 3% of the global population. They are characterized by a dilation of the vascular wall within the intracranial region, typically at a bifurcation. The most feared complication of IA is rupture, which is associated with high morbidity and mortality. About 30% of patients face death or severe disability, and even among those with no visible sequelae, up to 50% suffer from invisible disabilities such as cognitive problems. This explains the significant economic burden of ruptured IAs, estimated at approximately £168 million annually in the UK.

One way to reduce this morbidity and societal burden is to identify patients at high risk of rupture to determine those most likely to experience disease progression. Various initiatives, such as the ELAPSS, PHASES, and UCAS scores, have been developed to assess rupture risk in routine clinical practice. However, these scores largely rely on well-known modifiable and non-modifiable risk factors, such as ethnicity, hypertension, sex, age, smoking, and history of subarachnoid hemorrhage. Despite their utility, they are insufficient for reliably stratifying rupture risk, underestimating it by approximately 30%, which limits their impact in daily practice.

Recent research has identified emerging risk and protective factors, such as sleep apnea syndrome, lipid control, and the use of antidiabetic, lipid-lowering, or antihypertensive treatments. Therefore, it is necessary to revisit IA rupture risk by considering these factors in relation to patients' living environments.

Social determinants of health (SDOH) play a critical role in this context. Defined as the conditions of life that influence individual and population health, SDOH include broad factors such as age, ethnicity, and gender, as well as addiction behaviors, income levels, environmental exposure, and social status. They are estimated to contribute to over 80% of the population's health outcomes. In vascular diseases, SDOH -such as low education levels, limited income, social isolation, and low physical activity-are known to impact disease severity beyond traditional risk factors. The WHO estimates that vascular diseases are the leading global cause of mortality, with 17.7 million deaths annually, half of which are preventable. Understanding and addressing SDOH is therefore crucial for public health prevention efforts.

Initial studies on the impact of SDOH on IA rupture are limited, often focusing on individual determinants. A more comprehensive approach to SDH is needed, especially given the lack of consensus guidelines for IA management. Current therapeutic options, while advanced, still carry perioperative morbidity. Multivariable modeling and weighted composite scores can help address the complexity of clinical and environmental factors.