Article
Worldwide incidence of aneurysmal subarachnoid haemorrhage in relation to region, time period, blood pressure and smoking prevalence in the population – a systematic review and meta-analysis
Weltweite Inzidenz der aneurysmatischen Subarachnoidalblutung in Bezug auf Region, Zeitraum, Prävalenz von Blutdruck und Rauchen in der Bevölkerung – ein systematischer Review und Metaanalyse
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Published: | May 8, 2019 |
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Outline
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Objective: Subarachnoid haemorrhage (SAH) from ruptured intracranial aneurysms is a subset of stroke that has a high burden on an individual patient but also on the socio-economic level, because of its high case-fatality and high proportion of functional impairments in survivors. A better understanding of determinants for SAH incidence could facilitate primary prevention strategies.
Methods: We searched Pubmed for population-based studies on SAH incidence, with prospective design with the study population being representative of the specific population according to pre-defined criteria, published January 1960 – March 2017. Worldwide blood pressure and smoking prevalence data was extracted from the Non-communicable disease and Global Burden of Disease datasets. SAH incidence was calculated per 100,000 person-years and risk ratios (RR) including 95% confidence intervals (95%CI) with multivariable random-effects binomial regression. The association between SAH incidence and blood pressure and smoking prevalence was assessed with linear regression.
Results: In 75 studies with 8,176 SAH patients in 67,746,051 person-years in 32 countries, overall crude SAH incidence across all midyears was 7.9 (95% CI: 6.9–9.0) per 100,000 person-years; the RR for women was 1.27 (95% CI: 0.98–1.66). In Japanese women >75 years the RR was 2.5 (95% CI: 1.8–3.4) and in European women >75 years the RR was 1.5 (95% CI: 0.9–2.5), both in comparison with men aged 45–54. Global SAH incidence declined from 10.2 (95% CI: 8.4–12.5) in 1980 to 6.1 (95% CI: 4.9–7.5) per 100,000 person-years in 2010 or by 1.7% (95% CI: 0.6–2.8) annually between 1955 and 2014. Between 1980 and 2010 SAH incidence diminished in Europe by 61%, in Asia excluding Japan by 46%, and in North-America by 14%, and increased by 37% in Japan. The global SAH incidence declined with every mmHg decrease in systolic blood pressure by 7.1% (95% CI: 5.8-8.4), and with every percent decrease in smoking prevalence by 2.4% (95% CI: 1.6–3.3).
Conclusion: We report for the first time a genuine decline in the worldwide SAH incidence, which parallels a decrease in blood pressure and smoking prevalence. Understanding determinants for regional differences as well as further blood pressure and smoking reduction may yield a decrease in SAH incidence and a diminished SAH burden.
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