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Tetsuji Inagawa, MDBackground and Purpose-With aging of the population, the profile of subarachnoid hemorrhage (SAH) is likely to change; however, evaluation of long-term trends for incidence and case fatality rates of SAH is still limited. Methods-We compared the incidence and case fatality rates of aneurysmal SAH during the 9-year period 1990 -1998 with those during the 10-year period 1980 -1989 in Izumo City, Japan. Results- During 1980During -1989During and 1990During -1998, we diagnosed 170 and 188 patients as having aneurysmal SAH, respectively.The percentage of very elderly patients aged Ն80 years increased from 5% (8 patients) during 1980 -1989 to 18% (33 patients) during 1990 -1998 (PϽ0.001). The age-specific incidence rate of SAH has a tendency to increase with increasing age. The crude and the age-and sex-adjusted incidence rates using the 1995 population statistics for Japan were 21 and 23 per 100 000/y for all ages during 1980 -1989 and 25 and 23 per 100 000/y during 1990 -1998, respectively. The 3-month case fatality rate of patients aged Յ79 years decreased from 38% during 1980 to 26% during 1990, whereas the case fatality rates in patients aged Ն80 years were very high (63% and 79%, respectively) regardless of study periods. Consequently, the overall case fatality rates for patients with SAH were similar for the 2 study periods (39% and 36%). Conclusions-The age-and sex-adjusted incidence rates of aneurysmal SAH were stable over the 19-year period since 1980 and, despite improvement of outcome in patients aged Յ79 years, the overall case fatality rate was not lower because the improvements were counterbalanced by increasing numbers of very elderly patients. Key Words: cerebral aneurysm Ⅲ epidemiology Ⅲ incidence Ⅲ Japan Ⅲ subarachnoid hemorrhage J

The incidence rate of subarachnoid hemorrhage is much higher than that reported so far in the literature, and despite improvement of management and surgical therapy, the actual case-fatality rate is still high, mainly because of the high mortality rate directly associated with the primary bleeding.

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The actual incidence rates of both primary ICH and aneurysmal SAH seem to be much higher than have been reported so far. In addition, the data indicate the existence of seasonal periodicity for men and younger patients with ICH, and that the risk of both ICH and SAH is lower during nighttime.

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Marked differences were observed in the incidence rates and outcome of primary ICH in relation to the site of hemorrhage. The differences in outcome were primarily a result of differences in the severity of bleeding for each ICH subtype.

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