title: Incidence and Mortality of Spontaneous Subarachnoid Hemorrhage in Martinique.
abstract: Incidence of spontaneous subarachnoid hemorrhages (SAH) varies wildly across the world and seems to be low in Central and South America (4.2 per 100 000 person-years; CI 95%; 3.1-5.7). The objective of our study was to describe the characteristics of SAH and to estimate its incidence and severity in Martinique, a small French island located in the Caribbean Sea.
  
  
  
  Due to its insular nature and small captive population, Martinique is ideal for the setting up of population-based epidemiological studies with good exhaustiveness. Our study, spanning a 7 year period (2007-2013), consisted of retrospective case ascertainment with multiple overlapping methods. Crude incidence and 30 day case-fatality rates for SAH among the Martinican population were computed for the study period. Incidence and disease severity was also analyzed according to age, gender and aneurysm presence. World age-standardized incidence rates were also calculated.
  
  
  
  A total of 121 patients had a SAH during the study period, with a higher frequency of female cases (71.1% versus 28.9%, p<0.001). Patient mean age was 57.1 years (median = 55 [46-66]). An aneurysmal origin was found in 96 SAH cases (79.3%). Crude annual incidence was 4.36 per 100 000 person-years (CI 95% 2.30-6.42). World age-standardized incidence was 3.29 per 100 000 person-years (CI 95% 1.74-4.84). During the 30 days following SAH diagnosis, 29 patients died (case fatality rate: 24% (CI 95% 16.4-31.6)).
  
  
  
  The incidence of spontaneous subarachnoid hemorrhage in Martinique is much lower than in other parts of the world and similar to countries in Central and South America. These results are possibly related to environmental factors and most particularly to a low rate of smoking in the Martinican population. Thirty-day case-fatality rate is similar to what is observed in developed countries.
authors.affiliation: Department of Neuroradiology, University Hospital of Martinique, Fort de France, Martinique (FWI).
authors.forename: Mathieu
authors.identifier: 0000-0002-2183-2426
authors.initials: M
authors.lastname: Schertz
authors.affiliation: Department of Critical Care and Emergency, University Hospital of Martinique, Fort de France, Martinique (FWI).
authors.forename: Hossein
authors.initials: H
authors.lastname: Mehdaoui
authors.affiliation: Department of Neurosurgery, University Hospital of Martinique, Fort de France, Martinique (FWI).
authors.forename: Abderrahmane
authors.initials: A
authors.lastname: Hamlat
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
authors.affiliation: Clinical Research Department, University Hospital of Martinique, Fort de France, Martinique (FWI).
authors.forename: Rishika
authors.initials: R
authors.lastname: Banydeen
authors.affiliation: Department of Neuroradiology, University Hospital of Martinique, Fort de France, Martinique (FWI).
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mejdoubi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008395:Martinique / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D012727:Sex Characteristics; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000401:mortality