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. 2014 Jun 17;82(24):2180-6.
doi: 10.1212/WNL.0000000000000519. Epub 2014 May 16.

Intracerebral hemorrhage mortality is not changing despite declining incidence

Darin B Zahuranec  1 , Lynda D Lisabeth  2 , Brisa N Sánchez  2 , Melinda A Smith  2 , Devin L Brown  2 , Nelda M Garcia  2 , Lesli E Skolarus  2 , William J Meurer  2 , James F Burke  2 , Eric E Adelman  2 , Lewis B Morgenstern  2
Affiliations

Intracerebral hemorrhage mortality is not changing despite declining incidence

Darin B Zahuranec et al. Neurology. .

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 -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.

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.

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Figures

Figure 1
Figure 1. Trend in adjusted intracerebral hemorrhage incidence rate
Points represent the model-predicted incidence treating year as a categorical variable. Smoothed lines represent the model-predicted incidence assuming a linear trend. (A) Overall age-, sex-, and ethnicity-adjusted rates for all individuals 45 and older. (B) Sex- and ethnicity-adjusted rates by age group.
Figure 2
Figure 2. Trend in adjusted intracerebral hemorrhage 30-day case fatality
Points represent the model-predicted mortality treating year as a categorical variable. Smoothed lines represent the model-predicted mortality assuming a linear trend with time. (A) Adjusted for age (quadratic due to nonlinear effects), sex, and ethnicity. (B) Additionally adjusted for NIH Stroke Scale (quadratic due to nonlinear effects), Glasgow Coma Scale, coronary disease, prior stroke/TIA, atrial fibrillation, diabetes, and smoking.
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References

    1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics: 2013 update: a report from the American Heart Association. Circulation 2013;127:e6–e245 - PMC - PubMed
    1. Morgenstern LB, Smith MA, Sanchez BN, et al. Persistent ischemic stroke disparities despite declining incidence in Mexican Americans. Ann Neurol 2013;74:778–785 - PMC - PubMed
    1. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010;9:167–176 - PubMed
    1. Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol 2012;60:599–606 - PubMed
    1. Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH Stroke Scale. Stroke 2000;31:858–862 - PubMed

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