title: Trends in incidence and in short term survival following a subarachnoid haemorrhage in Scotland, 1986-2005: a retrospective cohort study.
abstract: BACKGROUND
  To examine age and sex specific incidence and 30 day case fatality for subarachnoid haemorrhage (SAH) in Scotland over a 20 year period.
  
  
  METHODS
  A retrospective cohort study using routine hospital discharge data linked to death records.
  
  
  RESULTS
  Between 1986 and 2005, 12,056 individuals experienced an incident SAH. Of these 10,113 (84%) survived to reach hospital. Overall age-standardised incidence rates were greater in women than men and remained relatively stable over the study period. In 2005, incidence in women was 12.8 (95% CI 11.5 to 14.2) and in men 7.9 (95% CI 6.9 to 9.1). 30 day case fatality in individuals hospitalised with SAH declined substantially, falling from 30.0% in men and 33.9% in women in 1986-1990 to 24.5% in men and 29.1% in women in 2001-2005. For both men and women, the largest reductions were observed in those aged between 40 to 59 years. After adjustment for age, socio-economic status and co-morbidity, the odds of death at 30 days in 2005 compared to odds of death in 1986 was 0.64 (0.54 to 0.76), p < 0.001 for those below 70 years, and 1.14 (0.83 to 1.56), p = 0.4 in those 70 years and above.
  
  
  CONCLUSIONS
  Incidence rates for SAH remained stable between 1986 and 2005 suggesting that a better understanding of SAH risk factors and their reduction is needed. 30 day case fatality rates have declined substantially, particularly in middle-age. However, they remain high and it is important to ensure that this is not due to under-diagnosis or under-treatment.
authors: NHS Quality Improvement Scotland, Glasgow, UK. karen.macpherson@nhs.net.
authors: Karen J
authors: KJ
authors: Macpherson
authors: James D
authors: JD
authors: Lewsey
authors: Pardeep S
authors: PS
authors: Jhund
authors: Michelle
authors: M
authors: Gillies
authors: Jim W T
authors: JW
authors: Chalmers
authors: Adam
authors: A
authors: Redpath
authors: Andrew
authors: A
authors: Briggs
authors: Matthew
authors: M
authors: Walters
authors: Peter
authors: P
authors: Langhorne
authors: Simon
authors: S
authors: Capewell
authors: John J V
authors: JJ
authors: McMurray
authors: Kate
authors: K
authors: MacIntyre
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology*; D013997:Time Factors