Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database.
OBJECTIVE Aging of the population may lead to epidemiological changes with respect to chronic subdural hematoma (CSDH). The objectives of this study were to elucidate the current epidemiology and changing trends of CSDH in Japan. The authors analyzed patient information based on reports using a Japanese administrative database associated with the diagnosis procedure combination (DPC) system. METHODS This study included patients with newly diagnosed CSDH who were treated in hospitals participating in the DPC system. The authors collected data from the administrative database on the following clinical and demographic characteristics: patient age, sex, and level of consciousness on admission; treatment procedure; and outcome at discharge. RESULTS A total of 63,358 patients with newly diagnosed CSDH and treated in 1750 DPC participation hospitals were included in this study. Analysis according to patient age showed that the most common age range for these patients was the 9th decade of life (in their 80s). More than half of patients 70 years old or older presented with some kind of disturbance of consciousness. Functional outcomes at discharge were good in 71.6% (modified Rankin Scale [mRS] score 0-2) of cases and poor in 28.4% (mRS score 3-6). The percentage of poor outcomes tended to be higher in elderly patients. Approximately 40% of patients 90 years old or older could not be discharged to home. The overall recurrence rate for CSDH was 13.1%. CONCLUSIONS This study shows a chronological change in the age distribution of CSDH among Japanese patients, which may be affecting the prognosis of this condition. In the aging population of contemporary Japan, patients in their 80s were affected more often than patients in other age categories, and approximately 30% of patients with CSDH required some help at discharge. CSDH thus may no longer have as good a prognosis as had been thought.
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Hiroyuki
H
Toi
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Keita
K
Kinoshita
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Satoshi
S
Hirai
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Hiroki
H
Takai
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Keijiro
K
Hara
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Nobuhisa
N
Matsushita
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Shunji
S
Matsubara
2Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka; and.
Makoto
M
Otani
2Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka; and.
Keiji
K
Muramatsu
2Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka; and.
Shinya
S
Matsuda
3Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo,Japan.
Kiyohide
K
Fushimi
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama.
Masaaki
M
Uno
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000453:epidemiology / Q000628:therapy; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
CSDH = chronic subdural hematoma; DPC = diagnosis procedure combination; ICD-10 = International Statistical Classification of Diseases and Related Health Problems, 10th Revision; Japan; chronic subdural hematoma; epidemiology; mRS = modified Rankin Scale; national administrative database; trauma