Intracerebral hemorrhage mortality is not changing despite declining incidence.
OBJECTIVE
To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study.


METHODS
We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease.


RESULTS
A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was -31% (95% CI -47%, -11%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time.


CONCLUSIONS
ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death.
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor. zdarin@umich.edu.
Darin B
DB
Zahuranec
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Lynda D
LD
Lisabeth
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Brisa N
BN
Sánchez
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Melinda A
MA
Smith
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Devin L
DL
Brown
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Nelda M
NM
Garcia
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Lesli E
LE
Skolarus
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
William J
WJ
Meurer
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
James F
JF
Burke
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Eric E
EE
Adelman
From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
Lewis B
LB
Morgenstern
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality*; D018672:Community Health Planning; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology