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Review
. 2021 Sep;163(9):2629-2637.
doi: 10.1007/s00701-021-04879-z. Epub 2021 Jun 28.

Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature

D J Stubbs  1 , M E Vivian  2 , B M Davies  3 , A Ercole  2 , R Burnstein  2 , A J Joannides  3
Affiliations
Review

Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature

D J Stubbs et al. Acta Neurochir (Wien). 2021 Sep.

Abstract

Background: Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning.

Methods: This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015-2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics.

Results: We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4-2.2) to 5.3/100,000/year (4.3-6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0-11.2) to 48/100,000/year (37.7-61.1). Four pairs of studies demonstrated incidence rate increases of 200-600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19-3.85). Directly standardised incidence was 1.58/100,000/year (1.26-1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years.

Conclusions: The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.

Keywords: Chronic subdural haematoma; Epidemiology; Health service planning; Incidence.

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Figures

Fig. 1
Fig. 1
Article inclusion in systematic literature search for incidence estimates of chronic subdural haematoma
Fig. 2
Fig. 2
Projected number of operations for chronic subdural haematoma (cSDH) from our study region between 2025 and 2040. Calculations assume constant local incidence but changing population age structure based on office for national statistics population projections. Error bars demonstrate upper and lower bounds of estimates based on 95% confidence intervals for locally calculated incidence rate
See this image and copyright information in PMC

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