MedWire News: The incidence of intracerebral hemorrhage (ICH) has not fallen over the past 20 years, show results of a meta-analysis published in The Lancet Neurology.
Dutch researchers led by Charlotte van Asch (University Medical Centre Utrecht) collated data from 36 population-based studies published between 1980 and 2008. Most studies were European or Australian, but other countries included Japan, China, Barbados, Brazil, India, and the USA.
These studies included 8145 patients with ICH, giving an overall incidence of 24.6 per 100,000 person-years, which did not substantially change over the study period.
Older people were more vulnerable to ICH, with an incidence of 1.9 per 100,000 person-years in those aged 44 years or younger compared with 196.0 per 100,000 person-years in those aged 85 years or older.
Asian people were most prone to ICH, at an incidence of 51.8 per 100,000 person-years compared with 24.2, 22.9, and 19.6 per 100,000 person-years in White, Black, and Hispanic people, respectively.
However, case–fatality was lowest in Japan, at 16.7% versus 42.3% in other countries. The researchers note that Japanese studies also report a high incidence but low case–fatality for subarachnoid hemorrhage. They speculate that either the Japanese studies, which did not involve family doctors, missed patients who died early of their ICH, or that aggressive treatment strategies improved survival rates.
“These differences emphasize the importance of research into effective acute interventions for ICH, a disorder that has received far less attention than has ischemic stroke,” said Geoffrey Donnan (University of Melbourne, Australia) and colleagues in an accompanying commentary.
They said it is hard to explain why ICH incidence has not fallen in recent years, and suggested that reductions through better blood pressure control may have been offset by increases in cases related to amyloid angiopathy and antithrombotic drug use.
But the team noted: “Because most incident stroke events occur in developing countries, which usually have high proportions of ICH, a refocusing of the global epidemiologic effort and the setting of new research directions is sorely needed.”
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