A Multinational Comparison of Subarachnoid Hemorrhage Epidemiology in the WHO MONICA Stroke Study

Abstract

Background and Purpose-By official, mostly unvalidated statistics, mortality from subarachnoid hemorrhage (SAH) show large variations between countries. Using uniform criteria for case ascertainment and diagnosis, a multinational comparison of attack rates and case fatality rates of SAH has been performed within the framework of the WHO MONICA Project. Methods-In 25-to 64-year-old men and women, a total of 3368 SAH events were recorded during 35.9 million person-years of observation in 11 populations in Europe and China. Strict MONICA criteria were used for case ascertainment and diagnosis of stroke subtype. Case fatality was based on follow-up at 28 days after onset. Results-Age-adjusted average annual SAH attack rates varied 10-fold among the 11 populations studied, from 2.0 (95% CI 1.6 to 2.4) per 100 000 population per year in China-Beijing to 22.5 (95% CI 20.9 to 24.1) per 100 000 population per year in Finland. No consistent pattern was observed in the sex ratio of attack rates in the different populations. The overall 28-day case fatality rate was 42%, with 2-fold differences in age-adjusted rates between populations but little difference between men and women. Case fatality rates were consistently higher in Eastern than in Western Europe. Conclusions-Using a uniform methodology, the WHO MONICA Project has shown very large variations in attack rates of SAH across 11 populations in Europe and China. The generally accepted view that women have a higher risk of SAH than men does not apply to all populations. Marked differences in outcome of SAH add to the wide gap in the burden of stroke between East and West Europe.

Growth rates of intracranial aneurysms: exploring constancy

“…During the selection of relevant data from the literature, we placed emphasis on the general applicability of data. Because calculations of aneurysm prevalence and rupture risk vary widely among studies and populations, 8,20 we collected estimates from either systematic reviews or multinational studies whenever available. The calculation of incidence rates, IDRs, and corresponding CIs was based on the number of actual SAH incidents and the number of person-years in which these incidents occurred.…”

“…, 55-59, and 60-64 years, for 11 different populations. 8 In a systematic review based on 5 autopsy and 5 angiography studies, the prevalence of aneurysms in the age categories 20-39, 40-59, and 60-79 years was provided. 20 We combined these data and calculated the age-specific annual risk of aneurysm rupture (Table 3).…”

20-HETE contributes to the acute fall in cerebral blood flow after subarachnoid hemorrhage in the rat

“…The incidence is 2-20 events per 100,000 population per year with a case fatality rate of 20-60% (3,21). SAH typically occurs after rupture of cerebral aneurysms or head trauma leading to subarachnoid bleeding and clot formation.…”

The histopathological and stereological assessment of the effect of topically administered leptin on cerebral vasospasm in an experimental subarachnoid hemorrhage model

“…It is most commonly secondary to trauma but may also develop spontaneously without any underlying cause. The actual incidence is not known exactly because approximately 10% to 15% of patients with subarachnoid hemorrhage die without any medical intervention (1). SAH occurs most commonly in people aged 60 and over.…”