Spontaneous subarachnoid hemorrhage epidemiology [Neurosurgery Wiki]

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====== Spontaneous subarachnoid hemorrhage epidemiology ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NwSQ1kPYoZRBGXGyrk3xa0m_msvH1zOlCDSF4HmEJ4IWQ-QOD/?limit=15&utm_campaign=pubmed-2&fc=20250523180241}}

===== Incidence =====

Global incidence: ~6–10 cases per 100,000 person-years.

Higher incidence in:

Japan and Finland (~20 per 100,000),

Lower in North America and some parts of Europe.

Declining trend in many high-income countries over the past decades, possibly due to reduced smoking and better hypertension control.

===== Age and Gender =====

Peak incidence: 50–60 years of age.

Gender distribution: More common in women (female-to-male ratio ≈ 1.5:1).

Increased risk with age, though aneurysmal SAH can occur in younger adults.

===== Risk Factors =====

Modifiable:

Smoking (the strongest independent risk factor),

Hypertension,

Excessive alcohol consumption,

Cocaine use.

Non-modifiable:

Female sex,

Family history of SAH or aneurysms,

Certain genetic syndromes (e.g., polycystic kidney disease, Ehlers-Danlos type IV).

===== Mortality and Morbidity =====

Case fatality rate: ~30–40% within the first month.

Sudden death: ~10–15% die before reaching hospital.

Survivors: Up to 50% have long-term neurological or cognitive deficits.

Rebleeding: High risk in the first 24–48 hours if the aneurysm is not secured.

===== Regional Differences =====

High-income countries: Better outcomes due to timely diagnosis, endovascular/surgical treatment, and intensive care.

Low- and middle-income countries: Underdiagnosis and lack of resources may lead to underestimation of incidence and worse outcomes.

===== Recent Trends =====

Increasing use of non-invasive imaging (e.g., CT angiography) improves early detection.

Shift toward endovascular coiling over clipping in many centers.

===== Descriptive Epidemiological Studies =====

In a Descriptive Epidemiological Study, the GBD 2021 Global Subarachnoid Hemorrhage Risk Factors Collaborators estimated the worldwide burden of SAH.

Design, setting, and participants: The repeated cross-sectional Global Burden of Disease (GBD) 2021 study estimated the global burden of SAH from 1990 to 2021. 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.

Exposures: SAH and 14 modifiable risk factors.

Main outcomes and measures: 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).

Results: 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 the 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
((GBD 2021 Global Subarachnoid Hemorrhage Risk Factors Collaborators; Rautalin I, Volovici V, Stark BA, Johnson CO, Kaprio J, Korja M, Krishnamurthi RV, Nair BS, Ranta A, Rinkel GJE, Vergouwen MDI, Abate YH, Abbastabar H, Abd-Allah F, Abdelkader A, Abdi P, Abdollahi A, Abdullahi A, Abiodun OO, Aboagye RG, Abouzid M, Abtahi D, Abu Rumeileh S, Abualhasan A, Abualruz H, Abukhadijah HJ, Abu-Zaid A, Adamu LH, Addo IY, Adedoyin RA, Adegboye OA, Adra S, Adzigbli LA, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmadzade AM, Ahmed A, Ahmed H, Ahmed SA, Aji B, Akkaif MA, Al-Ajlouni Y, Al-Aly Z, Albashtawy M, Ali MU, Alif SM, Alimohamadi Y, Aljunid SM, Alomari MA, Alrawashdeh A, Alsabri MA, Salman RA, Altaf A, Al-Tammemi AB, Alvis-Guzman N, Alwafi H, Al-Wardat M, Al-Worafi YM, Aly H, Alyahya MSI, Alzoubi KH, Amani R, Amin TT, Amindarolzarbi A, Amusa GA, Anderlini D, Angappan D, Anil A, Anuoluwa BS, Anwar S, Anyasodor AE, Apostol GLC, Arabloo J, Areda D, Ärnlöv J, Artamonov AA, Artanti KD, Arumugam A, Aryan Z, Asghari-Jafarabadi M, Ashemo MY, Ashraf T, Athar M, Athari SS, Aujayeb A, Awotidebe AW, Azadnajafabad S, Aziz S, Azzam AY, Babu GR, Bagheri N, Bahrami Taghanaki P, Bahramian S, Bai R, Baig AA, Bako AT, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik B, Bardhan M, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Barua L, Bastan MM, Basu S, Bell SL, Bensenor IM, Berhie AY, Beyene KA, Bhagavathula AS, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bijani A, Bikbov B, Birhan MM, Birhanu MM, Bitra VR, Boloor A, Borhany H, Breitner S, Brenner H, Bugiardini R, Bulamu NB, Butt ZA, Cabral LS, Caetano Dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato I, Capodici A, Carvalho F, Castañeda-Orjuela CA, Catapano AL, Cegolon L, Chadwick J, Chakraborty C, Chakraborty PA, Chakraborty S, Chandika RM, Chanie GS, Chattu VK, Chaudhary AA, Chi G, Chichagi F, Ching PR, Chopra H, Choudhari SG, Chowdhury EK, Chu DT, Chung SC, Columbus A, Criqui MH, da Silva AG, Dabbagh Ohadi MA, Dadras O, Dai X, Dalal K, Dalli LL, D'Amico E, Dashti M, Davletov K, De la Cruz-Góngora V, Debopadhaya S, Delgado-Enciso I, Derviševic E, Devanbu VGC, Dewan SMR, Dhane AS, Dibas M, Do TC, Do THP, Dohare S, Doheim MF, Dokova KG, Dongarwar D, D'Oria M, Doshi OP, Doshi RP, Dowou RK, Dsouza HL, Dutta S, Dziedzic AM, E'mar AR, Edvardsson D, Efendi D, Efendi F, El Nahas N, Elgendy IY, Elhadi M, Eltaha C, Eltahir ME, Emeto TI, Fabin N, Fagbamigbe AF, Fahim A, Fakhradiyev IR, Fares J, Faris PS, Fauk NK, Fazylov T, Fekadu G, Ferreira N, Fetensa G, Fischer F, Foschi M, Fridayani NKY, Gaipov A, Gajjar AA, Gandhi AP, Ganesan B, Garg RK, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Getie M, Ghadimi DJ, Ghadirian F, Ghahramani S, Ghasemzadeh A, Ghazy RM, Gholamalizadeh M, Ghozy S, Gil AU, Gilani JA, Gnedovskaya EV, Goleij P, Goulart AC, Goulart BNG, Guan SY, Gupta S, Habibzadeh F, Hadei M, Hadi NR, Hamidi S, Hanifi N, Hankey GJ, Harlianto NI, Haro JM, Hasan F, Hasani H, Hasnain MS, Hassan Zadeh Tabatabaei MS, Haubold J, Havmoeller RJ, Hay SI, Hbid Y, Heidari G, Heidari M, Hemmati M, Hiraike Y, Hoan NQ, Holla R, Hosseinzadeh M, Hostiuc S, Huang J, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ikiroma A, Ilaghi M, Ilesanmi OS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Iso H, Isola G, Iwagami M, Jacob L, Jafarzadeh A, Jain A, Jairoun AA, Jakovljevic M, Jatau AI, Jawaid T, Jayapal SK, Jonas JB, Joseph N, Jürisson M, Kadashetti V, Kalani R, Kamal VK, Kamireddy A, Kanchan T, Kandel H, Karami J, Karaye IM, Karimi Y, Karimi Behnagh A, Kashoo FZ, Kayode GA, Kazemi F, Kesse-Guyot E, Khader YS, Khaing IK, Khan F, Khan MJ, Khatatbeh H, Khatatbeh MM, Khayat Kashani HR, Kheirallah KA, Khidri FF, Khormali M, Khosla AA, Kim K, Kim YJ, Kisa A, Kisa S, Kivimäki M, Kolahi AA, Kompani F, Korzh O, Kostev K, Kothari N, Krishan K, Krishna V, Krishnamoorthy V, Kuddus M, Kulimbet M, Kunutsor SK, Kurniasari MD, Kusuma D, Kytö V, La Vecchia C, Lahariya C, Lai DTC, Lai H, Laksono T, Lallukka T, Latief K, Latifinaibin K, Le NHH, Le TTT, Lee M, Lee SW, Lee WC, Lee YH, Lenzi J, Leonardi M, Li MC, Li X, Lim SS, Lin J, Liu X, Lohner V, Lorenzovici L, Lotufo PA, Lucchetti G, Lusk JB, Lutzky Saute R, M Amin HI, Malhotra AK, Malhotra K, Malik AA, Malta DC, Mansournia MA, Mantovani LG, Manu E, Marateb HR, Marino M, Maroufi SF, Martinez-Piedra R, Martini S, Martorell M, Marzo RR, Mathangasinghe Y, Mathews E, Maugeri A, McPhail SM, Mehmood A, Mehndiratta MM, Mehrabani-Zeinabad K, Menezes RG, Meo SA, Meretoja A, Mestrovic T, Mettananda CDK, Miazgowski T, Micheletti Gomide Nogueira de Sá AC, Minervini G, Minh LHN, Mirica A, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Mishra AK, Mithra P, Mohamed AZ, Mohamed AI, Mohammad AM, Mohammadi S, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molinaro S, Momani S, Moni MA, Moodi Ghalibaf A, Moradi M, Moradi Y, Moraga P, Morawska L, Msherghi A, Munjal K, Murray CJL, Nagarajan AJ, Naik GR, Najdaghi S, Nakhostin Ansari N, Nargus S, Davani DN, Natto ZS, Nauman 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L, Tabaee Damavandi P, Tabatabaei SM, Tabatabaeizadeh SA, Tabche C, Taiba J, Talaat IM, Tamuzi JL, Tan KK, Temsah MH, Teramoto M, Thakur R, Thankappan KR, Thayakaran R, Thirunavukkarasu S, Ticoalu JHV, Tiwari K, Tonelli M, Topor-Madry R, Tovani-Palone MR, Tran AT, Tran JT, Tran TH, Tran Minh Duc N, Truelsen TC, Truyen TTTT, Tsai DH, Ullah A, Unim B, Unnikrishnan B, Unsworth CA, Usman JS, Vahdati S, Vaithinathan AG, Valizadeh R, Van den Eynde J, Varghese J, Vasankari TJ, Venketasubramanian N, Vervoort D, Villafañe JH, Vinayak M, Vladimirov SK, Wafa HA, Waheed Y, Wahood W, Walde MT, Wang Y, Wickramasinghe ND, Willeit P, Wolde AA, Wolfe CDA, Wubie YM, Xiao H, Xu S, Xu X, Yamagishi K, Yano Y, Yarahmadi A, Yaribeygi H, Yaya S, Ye P, Yon DK, Yonemoto N, Yu C, Zanghì A, Zare I, Zastrozhin M, Zhang C, Zhang Y, Zhang ZJ, Zhang Z, Zhao H, Zhou SC, Zhumagaliuly A, Zia H, Zielinska M, Zyoud SH, Roth GA, Feigin VL. Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021. JAMA Neurol. 2025 May 23. doi: 10.1001/jamaneurol.2025.1522. Epub ahead of print. PMID: 40406922.)).
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[[Spontaneous subarachnoid hemorrhage]] (SAH) is usually caused by a [[ruptured intracranial aneurysm]], but in some patients, no source of hemorrhage can be detected. 

[[Ruptured intracranial aneurysm]]s: 75-50% of [[spontaneous subarachnoid hemorrhage]]. 

The [[anterior communicating artery aneurysm]] causes [[aneurysmal subarachnoid hemorrhage]], about 21.0%~25.5% of percent of [[spontaneous subarachnoid hemorrhage]].



[[Data]] showed increasing numbers of cases of spontaneous [[Spontaneous nonaneurysmal subarachnoid hemorrhage]]. 

Accounts for only 5% of [[stroke]]s, but occurs at a fairly young age. 

The overall incidence of SAH is approximately 9 per 100,000 person-years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in the incidence of SAH over the past 45 years is relatively moderate compared with that for stroke in general
((de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of
subarachnoid haemorrhage: a systematic review with emphasis on region, age,
gender and time trends. J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1365-72.
Epub 2007 Apr 30. Review. PubMed PMID: 17470467; PubMed Central PMCID:
PMC2095631.
)).