Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021.
Journal: JAMA Neurology
Published:
Abstract
Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. To estimate the worldwide burden of SAH. Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. SAH and 14 modifiable risk factors. Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs). In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.
Authors
Victor Volovici, Benjamin Stark, Catherine Johnson, Jaakko Kaprio, Miikka Korja, Rita Krishnamurthi, Balakrishnan Nair, Annemarei Ranta, Gabriel J Rinkel, Mervyn D Vergouwen, Yohannes Abate, Hedayat Abbastabar, Foad Abd Allah, Atef Abdelkader, Parsa Abdi, Arash Abdollahi, Auwal Abdullahi, Olugbenga Abiodun, Richard Aboagye, Mohamed Abouzid, Dariush Abtahi, Samir Abu Rumeileh, Ahmed Abualhasan, Hasan Abualruz, Hana Abukhadijah, Ahmed Abu Zaid, Lawan Adamu, Isaac Addo, Rufus Adedoyin, Oyelola Adegboye, Saryia Adra, Leticia Adzigbli, Williams Agyemang Duah, Bright Ahinkorah, Aqeel Ahmad, Danish Ahmad, Amir Ahmadzade, Ali Ahmed, Haroon Ahmed, Syed Ahmed, Budi Aji, Mohammed Akkaif, Yazan Al Ajlouni, Ziyad Al Aly, Mohammed Albashtawy, Mohammed Ali, Sheikh Alif, Yousef Alimohamadi, Syed Aljunid, Mahmoud Alomari, Ahmad Alrawashdeh, Mohammed Alsabri, Rustam Salman, Awais Altaf, Alaa Al Tammemi, Nelson Alvis Guzman, Hassan Alwafi, Mohammad Al Wardat, Yaser Al Worafi, Hany Aly, Mohammad Sharif Alyahya, Karem Alzoubi, Reza Amani, Tarek Amin, Alireza Amindarolzarbi, Ganiyu Amusa, Deanna Anderlini, Dhanalakshmi Angappan, Abhishek Anil, Boluwatife Anuoluwa, Saleha Anwar, Anayochukwu Anyasodor, Geminn Louis Apostol, Jalal Arabloo, Demelash Areda, Johan Ärnlöv, Anton Artamonov, Kurnia Artanti, Ashokan Arumugam, Zahra Aryan, Mohammad Asghari Jafarabadi, Mubarek Ashemo, Tahira Ashraf, Mohammad Athar, Seyyed Athari, Avinash Aujayeb, Adedapo Awotidebe, Sina Azadnajafabad, Shahkaar Aziz, Ahmed Azzam, Giridhara Babu, Nasser Bagheri, Pegah Bahrami Taghanaki, Saeed Bahramian, Ruhai Bai, Atif Baig, Abdulaziz Bako, Ovidiu Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Mainak Bardhan, Suzanne Barker Collo, Till Bärnighausen, Hiba Barqawi, Lingkan Barua, Mohammad-mahdi Bastan, Sanjay Basu, Shelly Bell, Isabela Bensenor, Alemshet Berhie, Kebede Beyene, Akshaya Bhagavathula, Sonu Bhaskar, Ajay Bhat, Vivek Bhat, Gurjit Bhatti, Jasvinder Bhatti, Ali Bijani, Boris Bikbov, Mekuriaw Birhan, Mulugeta Birhanu, Veera Bitra, Archith Boloor, Hamed Borhany, Susanne Breitner, Hermann Brenner, Raffaele Bugiardini, Norma Bulamu, Zahid Butt, Lucas Cabral, Florentino Caetano Dos Santos, Daniela Calina, Luis Cámera, Luciana Campos, Ismael Campos Nonato, Angelo Capodici, Felix Carvalho, Carlos Castañeda Orjuela, Alberico Catapano, Luca Cegolon, Joshua Chadwick, Chiranjib Chakraborty, Promit Chakraborty, Sandip Chakraborty, Rama Chandika, Gashaw Chanie, Vijay Chattu, Anis Chaudhary, Gerald Chi, Fatemeh Chichagi, Patrick Ching, Hitesh Chopra, Sonali Choudhari, Enayet Chowdhury, Dinh-toi Chu, Sheng-chia Chung, Alyssa Columbus, Michael Criqui, Alanna Da Silva, Mohammad Dabbagh Ohadi, Omid Dadras, Xiaochen Dai, Koustuv Dalal, Lachlan Dalli, Emanuele D'amico, Mohsen Dashti, Kairat Davletov, Vanessa De La Cruz Góngora, Shayom Debopadhaya, Ivan Delgado Enciso, Emina Derviševic, Vinoth Gnana Devanbu, Syed Masudur Dewan, Amol Dhane, Mahmoud Dibas, Thanh Do, Thao Huynh Do, Sushil Dohare, Mohamed Doheim, Klara Dokova, Deepa Dongarwar, Mario D'oria, Ojas Doshi, Rajkumar Doshi, Robert Dowou, Haneil Dsouza, Siddhartha Dutta, Arkadiusz Dziedzic, Abdel E'mar, David Edvardsson, Defi Efendi, Ferry Efendi, Nevine El Nahas, Islam Elgendy, Muhammed Elhadi, Chadi Eltaha, Mohd Eltahir, Theophilus Emeto, Natalia Fabin, Adeniyi Fagbamigbe, Ayesha Fahim, Ildar Fakhradiyev, Jawad Fares, Pawan Faris, Nelsensius Fauk, Timur Fazylov, Ginenus Fekadu, Nuno Ferreira, Getahun Fetensa, Florian Fischer, Matteo Foschi, Ni Kadek Fridayani, Abduzhappar Gaipov, Avi Gajjar, Aravind Gandhi, Balasankar Ganesan, Ravindra Garg, Miglas Gebregergis, Mesfin Gebrehiwot, Teferi Gebremeskel, Molla Getie, Delaram Ghadimi, Fataneh Ghadirian, Sulmaz Ghahramani, Afsaneh Ghasemzadeh, Ramy Ghazy, Maryam Gholamalizadeh, Sherief Ghozy, Artyom Gil, Jaleed Gilani, Elena Gnedovskaya, Pouya Goleij, Alessandra Goulart, Barbara Niegia Goulart, Shi-yang Guan, Sapna Gupta, Farrokh Habibzadeh, Mostafa Hadei, Najah Hadi, Samer Hamidi, Nasrin Hanifi, Graeme Hankey, Netanja Harlianto, Josep Haro, Faizul Hasan, Hamidreza Hasani, Md Hasnain, Mahgol Hassan Zadeh Tabatabaei, Johannes Haubold, Rasmus Havmoeller, Simon Hay, Youssef Hbid, Golnaz Heidari, Mohammad Heidari, Mehdi Hemmati, Yuta Hiraike, Nguyen Hoan, Ramesh Holla, Mehdi Hosseinzadeh, Sorin Hostiuc, Junjie Huang, Hong-han Huynh, Bing-fang Hwang, Segun Ibitoye, Nayu Ikeda, Adalia Ikiroma, Mehran Ilaghi, Olayinka Ilesanmi, Irena Ilic, Milena Ilic, Md Islam, Nahlah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Louis Jacob, Abdollah Jafarzadeh, Akhil Jain, Ammar Jairoun, Mihajlo Jakovljevic, Abubakar Jatau, Talha Jawaid, Sathish Jayapal, Jost Jonas, Nitin Joseph, Mikk Jürisson, Vidya Kadashetti, Rizwan Kalani, Vineet Kamal, Arun Kamireddy, Tanuj Kanchan, Himal Kandel, Jafar Karami, Ibraheem Karaye, Yeganeh Karimi, Arman Karimi Behnagh, Faizan Kashoo, Gbenga Kayode, Foad Kazemi, Emmanuelle Kesse Guyot, Yousef Khader, Inn Khaing, Fayaz 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