Hemorrhagic stroke epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Intracerebral hemorrhage (ICH) constitutes 10,000 to 15,000 cases per 100,000 individuals with all kind of strokes and has a higher risk of morbidity and mortality than cerebral infarction or subarachnoid hemorrhage

Epidemiology and demographics

Prevalence

In 2013, the prevalence of hemorrhagic stroke was estimated at 116.6 cases per 100,000 individuals.[1]

Incidence

In 2013, the age-adjusted incidence of hemorrhagic stroke was estimated 54.3 cases per 100,000 individuals.[1]

Intracerebral hemorrhage

Subarachnoid hemorrhage

Age

Intracerebral hemorrhage

  • The incidence of intracerebral hemorrhage (ICH) increases with age, after age 35 every 10 years, the risk of having ICH is getting doubled.[4]
  • Primary lobar hemorrhages, due to cerebral amyloid angiopathy, are typically seen in elderly. Younger patients may also develop lobar hemorrhages, but in such cases they usually have an underlying lesion such as cerebral arteriovenous malformation (AVM).[5]

Subarachnoid hemorrhage

Gender

Subarachnoid hemorrhage

Race

intracerebral hemorrhage

  • The incidence of intracerebral hemorrhage is the highest in Asians, follow by blacks, and is the lowest in whites.
  • In African Americans, the incidence of hemorrhagic stroke (intracerebral hemorrhage) is 48 cases per 100,000 persons.
  • In whites, the incidence of hemorrhagic stroke (intracerebral hemorrhage) is 48 cases per 100,000 persons. [8]
  • The incidence of Intracerebral hemorrhage is higher in Mexican Americans than non-Hispanic whites.[9]

Subarachnoid hemorrhage

Geographic region

  • In the United States, the incidence of hemorrhagic stroke is 10 to 15 cases per 100,000 population.[11]
  • In China, the incidence of hemorrhagic stroke is 2 cases per 100,000 population.[12]
  • In South and Central America, the incidence of hemorrhagic stroke is 4 cases per 100,000 population.[13]
  • In Finland and Japan, the incidence of hemorrhagic stroke is 19 to 23 cases per 100,000 population. [14]

Case fatality rate

References

  1. 1.0 1.1 Global Burden of Disease Study 2013 Collaborators (2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/S0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
  2. Gebel JM, Broderick JP (2000). "Intracerebral hemorrhage". Neurol Clin. 18 (2): 419–38. PMID 10757834.
  3. van Gijn J, Rinkel GJ (2001). "Subarachnoid haemorrhage: diagnosis, causes and management". Brain. 124 (Pt 2): 249–78. PMID 11157554.
  4. Stein M, Misselwitz B, Hamann GF, Scharbrodt W, Schummer DI, Oertel MF (2012). "Intracerebral hemorrhage in the very old: future demographic trends of an aging population". Stroke. 43 (4): 1126–8. doi:10.1161/STROKEAHA.111.644716. PMID 22282880.
  5. Falcone GJ, Biffi A, Brouwers HB, Anderson CD, Battey TW, Ayres AM; et al. (2013). "Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage". JAMA Neurol. 70 (8): 988–94. doi:10.1001/jamaneurol.2013.98. PMC 3808840. PMID 23733000.
  6. 6.0 6.1 Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998). "Prevalence and risk of rupture of intracranial aneurysms: a systematic review". Stroke. 29 (1): 251–6. PMID 9445359.
  7. 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;78:1365–1372.
  8. Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L; et al. (2005). "Racial variations in location and risk of intracerebral hemorrhage". Stroke. 36 (5): 934–7. doi:10.1161/01.STR.0000160756.72109.95. PMID 15790947.
  9. Morgenstern LB, Smith MA, Lisabeth LD, Risser JM, Uchino K, Garcia N; et al. (2004). "Excess stroke in Mexican Americans compared with non-Hispanic Whites: the Brain Attack Surveillance in Corpus Christi Project". Am J Epidemiol. 160 (4): 376–83. doi:10.1093/aje/kwh225. PMC 1524675. PMID 15286023.
  10. Broderick JP, Brott T, Tomsick T, Huster G, Miller R (1992). "The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites". N Engl J Med. 326 (11): 733–6. doi:10.1056/NEJM199203123261103. PMID 1738378.
  11. Shea AM, Reed SD, Curtis LH, Alexander MJ, Villani JJ, Schulman KA (2007). "Characteristics of nontraumatic subarachnoid hemorrhage in the United States in 2003". Neurosurgery. 61 (6): 1131–7, discussion 1137-8. doi:10.1227/01.neu.0000306090.30517.ae. PMID 18162891.
  12. Ingall T, Asplund K, Mahonen M, Bonita R. A multinational com- parison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31:1054 –1061.
  13. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ (2007). "Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends". J Neurol Neurosurg Psychiatry. 78 (12): 1365–72. doi:10.1136/jnnp.2007.117655. PMC 2095631. PMID 17470467.
  14. Ingall T, Asplund K, Mähönen M, Bonita R (2000). "A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study". Stroke. 31 (5): 1054–61. PMID 10797165.
  15. Dennis, Martin S., et al. "Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project." Stroke 24.6 (1993): 796-800.
  16. Kleindorfer D., Broderick J., Khoury J., et al: The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. Stroke 2006; 37: pp. 2473-2478
  17. Woo, Daniel, and Joseph P. Broderick. "Spontaneous intracerebral hemorrhage: epidemiology and clinical presentation." Neurosurgery clinics of North America 13.3 (2002): 265-279.
  18. Feigin, Valery L., et al. "Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century." The Lancet Neurology 2.1 (2003): 43-53.


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