Intracerebral hemorrhage mortality is not changing despite declining incidence

• Published in: Neurology Vol. 82; no. 24; pp. 2180 - 2186
• Main Authors: ZAHURANEC, Darin B, LISABETH, Lynda D, MORGENSTERN, Lewis B, SANCHEZ, Brisa N, SMITH, Melinda A, BROWN, Devin L, GARCIA, Nelda M, SKOLARUS, Lesli E, MEURER, William J, BURKE, James F, ADELMAN, Eric E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 17-06-2014
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - mortality; Community Health Planning; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Incidence; Longitudinal Studies; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Regression Analysis; Retrospective Studies; Risk Factors; Survival Analysis; United States - epidemiology; Vascular diseases and vascular malformations of the nervous system; United States; Vascular disease; Nervous system diseases; Cerebral hemorrhage; Mortality; Central nervous system disease; Cardiovascular disease; Cerebrovascular disease; Cerebral disorder; Incidence
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0000000000000519

To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study.
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.
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 -31% (95% CI -47%, -11%). 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.
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.