Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population

Jason Mackey, Jane C. Khoury, Kathleen Alwell, Charles J. Moomaw, Brett M. Kissela, Matthew L. Flaherty, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Felipe De Los Rios La Rosa, Sharyl Martini, Pooja Khatri, Joseph P. Broderick, Mario Zuccarello, Dawn Kleindorfer

Research output: Contribution to journalArticle

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Abstract

Objective: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods. Results: The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%-18%, p 0.01; for trend), 30-day (46%-25%, p 0.001), and 90-day (49%-29%, p 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant. Conclusions: Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.

Original languageEnglish (US)
Pages (from-to)2192-2197
Number of pages6
JournalNeurology
Volume87
Issue number21
DOIs
StatePublished - Nov 22 2016

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Subarachnoid Hemorrhage
Mortality
Incidence
Population
Population Dynamics
Nervous System
Intensive Care Units
Stroke
Demography
Confidence Intervals
Physicians

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Mackey, J., Khoury, J. C., Alwell, K., Moomaw, C. J., Kissela, B. M., Flaherty, M. L., ... Kleindorfer, D. (2016). Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. Neurology, 87(21), 2192-2197. https://doi.org/10.1212/WNL.0000000000003353

Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. / Mackey, Jason; Khoury, Jane C.; Alwell, Kathleen; Moomaw, Charles J.; Kissela, Brett M.; Flaherty, Matthew L.; Adeoye, Opeolu; Woo, Daniel; Ferioli, Simona; De Los Rios La Rosa, Felipe; Martini, Sharyl; Khatri, Pooja; Broderick, Joseph P.; Zuccarello, Mario; Kleindorfer, Dawn.

In: Neurology, Vol. 87, No. 21, 22.11.2016, p. 2192-2197.

Research output: Contribution to journalArticle

Mackey, J, Khoury, JC, Alwell, K, Moomaw, CJ, Kissela, BM, Flaherty, ML, Adeoye, O, Woo, D, Ferioli, S, De Los Rios La Rosa, F, Martini, S, Khatri, P, Broderick, JP, Zuccarello, M & Kleindorfer, D 2016, 'Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population', Neurology, vol. 87, no. 21, pp. 2192-2197. https://doi.org/10.1212/WNL.0000000000003353
Mackey, Jason ; Khoury, Jane C. ; Alwell, Kathleen ; Moomaw, Charles J. ; Kissela, Brett M. ; Flaherty, Matthew L. ; Adeoye, Opeolu ; Woo, Daniel ; Ferioli, Simona ; De Los Rios La Rosa, Felipe ; Martini, Sharyl ; Khatri, Pooja ; Broderick, Joseph P. ; Zuccarello, Mario ; Kleindorfer, Dawn. / Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. In: Neurology. 2016 ; Vol. 87, No. 21. pp. 2192-2197.
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abstract = "Objective: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods. Results: The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95{\%} confidence interval 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32{\%}-18{\%}, p 0.01; for trend), 30-day (46{\%}-25{\%}, p 0.001), and 90-day (49{\%}-29{\%}, p 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant. Conclusions: Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.",
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AU - Kissela, Brett M.

AU - Flaherty, Matthew L.

AU - Adeoye, Opeolu

AU - Woo, Daniel

AU - Ferioli, Simona

AU - De Los Rios La Rosa, Felipe

AU - Martini, Sharyl

AU - Khatri, Pooja

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