TY - JOUR
T1 - Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage
T2 - The Global Burden of Disease Study 2021
AU - Rautalin, Ilari
AU - Volovici, Victor
AU - Stark, Benjamin A
AU - Johnson, Catherine O
AU - Kaprio, Jaakko
AU - Korja, Miikka
AU - Krishnamurthi, Rita V
AU - Nair, Balakrishnan Sukumaran
AU - Ranta, Annemarei
AU - Rinkel, Gabriel J E
AU - Vergouwen, Mervyn D I
AU - Abate, Yohannes Habtegiorgis
AU - Abbastabar, Hedayat
AU - Abd-Allah, Foad
AU - Abdelkader, Atef
AU - Abdi, Parsa
AU - Abdollahi, Arash
AU - Abdullahi, Auwal
AU - Abiodun, Olugbenga Olusola
AU - Aboagye, Richard Gyan
AU - Abouzid, Mohamed
AU - Abtahi, Dariush
AU - Abu Rumeileh, Samir
AU - Abualhasan, Ahmed
AU - Abualruz, Hasan
AU - Abukhadijah, Hana J
AU - Abu-Zaid, Ahmed
AU - Adamu, Lawan Hassan
AU - Addo, Isaac Yeboah
AU - Adedoyin, Rufus Adesoji
AU - Adegboye, Oyelola A
AU - Adra, Saryia
AU - Adzigbli, Leticia Akua
AU - Agyemang-Duah, Williams
AU - Ahinkorah, Bright Opoku
AU - Ahmad, Aqeel
AU - Ahmad, Danish
AU - Ahmadzade, Amir Mahmoud
AU - Ahmed, Ali
AU - Ahmed, Haroon
AU - Ahmed, Syed Anees
AU - Aji, Budi
AU - Akkaif, Mohammed Ahmed
AU - Al-Ajlouni, Yazan
AU - Al-Aly, Ziyad
AU - Albashtawy, Mohammed
AU - Ali, Mohammed Usman
AU - Alif, Sheikh Mohammad
AU - Alimohamadi, Yousef
AU - Truelsen, Thomas Clement
AU - GBD 2021 Global Subarachnoid Hemorrhage Risk Factors Collaborators
PY - 2025/8
Y1 - 2025/8
N2 - IMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.OBJECTIVE: To estimate the worldwide burden of SAH.DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021.EXPOSURES: SAH and 14 modifiable risk factors.MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs).RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution.CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.
AB - IMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.OBJECTIVE: To estimate the worldwide burden of SAH.DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021.EXPOSURES: SAH and 14 modifiable risk factors.MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs).RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution.CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.
UR - http://www.scopus.com/inward/record.url?scp=105006638300&partnerID=8YFLogxK
U2 - 10.1001/jamaneurol.2025.1522
DO - 10.1001/jamaneurol.2025.1522
M3 - Journal article
C2 - 40406922
SN - 2168-6149
VL - 82
SP - 765
EP - 787
JO - JAMA Neurology
JF - JAMA Neurology
IS - 8
ER -