Intracerebral hemorrhage mortality is not changing despite declining incidence

Abstract

Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. Methods:We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease.Results: A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was 231% (95% CI 247%, 211%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time.Conclusions: ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death. Intracerebral hemorrhage (ICH) accounts for about 10% of all strokes but a disproportionate amount of stroke mortality.1 Incidence of ischemic stroke is declining, 2 and due to shared risk factors, ICH incidence may be expected to be declining as well. Limited data exist on recent trends in ICH burden. Trends in ICH incidence and case fatality were the subject of a 2010 systematic review, 3 though most of the included 36 studies were from before 2000, and few were specifically designed to investigate time trends. An understanding of time trends in the epidemiology of ICH incidence, case fatality, and long-term mortality is necessary to gauge the effectiveness of stroke prevention and treatment efforts.Due to improved control of risk factors such as hypertension over the past decade, 4 there is a need for more recent data on trends in ICH. The objective of this analysis was to investigate trends in ICH incidence, 30-day case fatality, and long-term mortality from 2000 to 2010 within the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project.

Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage: A prospective observational study

“…2 We consider that this can be explained by improved control of arterial hypertension, though the mortality rate remains high and the functional outcomes are still poor, as evidenced by our own findings. This situation in turn is probably attributable to the increased use of anticoagulants and antiplatelet drugs.…”

“…Secondly, the median age of our patients was 60 years, and in this regard it is known that mortality in the 45---59 years age interval is even higher than among patients over 75 years of age. 2 The growing use of anticoagulants in younger populations as treatment for their background diseases or for prophylactic purposes has been shown to be an independent risk factor for mortality in ICH, and is associated to expansion of the hematoma or the recurrence of ICH. 7,20 In our series, 23.1% of the patients had received prior antiplatelet medication, and 13.4% were receiving oral anticoagulants.…”

Trends in Inpatient Mortality After Ischemic and Hemorrhagic Strokes in the United States

“…Recent studies of trends in stroke mortality in the United States are limited by inclusion of selective nonrepresentative populations with limited generalizability [6,7]. We studied stroke mortality trends from a nationally representative sample and found that adjusted relative mortality in recent years has decreased in adults with primary diagnosis of AIS by 7.3% (95% confidence interval: 7.1-7.6%), ICH by 5.2% (4.9-5.5%), and SAH by 5.2% (4.7-5.7%) annually in the United States.…”

Sparstolonin B improves neurological outcomes following intracerebral hemorrhage in mice

“…Despite decades of research, the mortality rates of patients that have experienced ICH have scarcely improved (3). Primary brain injury caused by hematoma formation following ICH occurs, which causes mechanical damage to adjacent tissues.…”