Decreasing incidence of subarachnoid hemorrhage

Nicholson, Patrick; O’Hare, Alan; Power, Sarah; Looby, Seamus; Javadpour, Mohsen; Thornton, John; Brennan, Paul

doi:10.1136/neurintsurg-2018-014038

Cited by 22 publications

(7 citation statements)

References 14 publications

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“…Therefore, there is little reason to expect changing community risk of subarachnoid haemorrhage. Our findings did not replicate Finnish 24 and Irish 25 studies, both utilising administrative data reporting declining subarachnoid haemorrhage rates in tandem with decreasing rates of smoking over 14 24 and 18 25 years. In NSW, the proportion of adults smoking daily has decreased from 16.0% to 12.0% between 2005 and 2013 26 with no observable impact on subarachnoid haemorrhage admissions, possibly because declines in relatively low smoking rates may have been insufficient to affect a comparatively low risk of subarachnoid haemorrhage.…”

Section: Discussioncontrasting

confidence: 93%

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Gattellari

Goumas

Jalaludin

et al. 2020

Preprint

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Background: Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery. Methods: We calculated admissions rates for ischaemic stroke, intracerebral haemorrhage or subarachnoid haemorrhage between January 1, 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to December 31st 2014 for patients aged 15 years or older from New South Wales, Australia (population 7.99 million). Annual Average Percentage Change in rates was estimated using negative binomial regression. Results: Of 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval=-3.5% to -0.9%) (p<0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change -2.9%, 95% Confidence Interval=-5.2% to -1.0%) (p=0.004) and subarachnoid haemorrhage (Average Percentage Change=-2.6%, 95% Confidence Interval=-4.8% to -0.2%) (p=0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in 30-day survivors of subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval=-0.1% to 12.8%), although the increase was not statistically significant (p=0.05). Conclusion: Improved prevention may have underpinned declining intracerebral haemorrhage rates while gains in survival suggest that innovations in stroke care are being successfully translated. Longer-term mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.

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Section: Discussioncontrasting

confidence: 93%

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Gattellari

Goumas

Jalaludin

et al. 2020

Preprint

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“…Our findings are in line with a recent study from Ireland that also observed an overall correlation between smoking rates and incidence rates of SAH in the Irish population [12]. Declining incidence rates of SAH were also reported in a systematic review published in 2007.…”

Section: Discussionsupporting

confidence: 93%

Smoking habits and detection rate of unruptured intracranial aneurysms and incidence rate of subarachnoid haemorrhage in Norway between 2008 and 2015

et al. 2020

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Objective The aim of this study was to investigate the detection rate of unruptured intracranial aneurysms (UIAs) and incidence of aneurysmal subarachnoid haemorrhage (SAH) in relation to the rapidly changing smoking rates in Norway between 2008 and 2015. Methods The registry-based study included all patients (≥ 16 years old) admitted to a hospital in Norway between 2008 and 2015 with a primary diagnosis of aneurysmal SAH or an outpatient diagnosis of UIAs. Age group–specific and total detection rate of UIAs and incidence rate of SAH over the years were calculated. Age group–specific data on smoking habits was retrieved from a national annual survey representative of the whole Norwegian population. Results The rate of daily smokers decreased by 48% between 2008 and 2015. The detection rate of UIAs decreased by 47% from 17.3 in 2008 to 9.3 per 100,000 persons in 2015, and the incidence of SAH decreased by 30% from 11.3 in 2008 to 7.9 per 100,000 persons in 2015. The average annual decline in prevalence of daily smoking, UIA detection rate, and SAH incidence was 6.9%, 6.7%, and 4.3% per year, respectively. Multinomial logistic regression analyses revealed that the correlation between the decline in estimated daily smoking rates and decline in detection rate of UIAs (hazard ratio 52.5 CI = (14.9,∞), p < 0.00001) and incidence of SAH (hazard ratio 11.8 CI=(5.6,32.5), p < 0.00001) are statistically significant. The association is particularly strong in young and middle-aged cohorts (< 66 years old). Conclusion It is likely that reducing cigarette smoking on a population-based level strongly reduces the rates of UIAs and SAH.

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“…Subarachnoid haemorrhage constitutes 5%‐10% of all strokes and is mainly (85%‐98.9%) caused by ruptured aneurysms . Typically, the basic pathophysiological changes during SAH can be divided into two periods: early brain injury (EBI) and delayed cerebral ischaemia (DCI) .…”

Section: The Pathophysiology Of Sahmentioning

confidence: 99%

The role and therapeutic potential of heat shock proteins in haemorrhagic stroke

Shao

Zhou

Yao

et al. 2019

J Cellular Molecular Medi

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Heat shock proteins (HSPs) are induced after haemorrhagic stroke, which includes subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH). Most of these proteins function as neuroprotective molecules to protect cerebral neurons from haemorrhagic stroke and as markers to indicate cellular stress or damage. The most widely studied HSPs in SAH are HSP70, haeme oxygenase‐1 (HO‐1), HSP20 and HSP27. The subsequent pathophysiological changes following SAH can be divided into two stages: early brain injury and delayed cerebral ischaemia, both of which determine the outcome for patients. Because the mechanisms of HSPs in SAH are being revealed and experimental models in animals are continually maturing, new agents targeting HSPs with limited side effects have been suggested to provide therapeutic potential. For instance, some pharmaceutical agents can block neuronal apoptosis signals or dilate cerebral vessels by modulating HSPs. HO‐1 and HSP70 are also critical topics for ICH research, which can be attributed to their involvement in pathophysiological mechanisms and therapeutic potential. However, the process of HO‐1 metabolism can be toxic owing to iron overload and the activation of succedent pathways, for example, the Fenton reaction and oxidative damage; the overall effect of HO‐1 in SAH and ICH tends to be protective and harmful, respectively, given the different pathophysiological changes in these two types of haemorrhagic stroke. In the present study, we focus on the current understanding of the role and therapeutic potential of HSPs involved in haemorrhagic stroke. Therefore, HSPs may be potential therapeutic targets, and new agents targeting HSPs are warranted.

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Decreasing incidence of subarachnoid hemorrhage

Cited by 22 publications

References 14 publications

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Smoking habits and detection rate of unruptured intracranial aneurysms and incidence rate of subarachnoid haemorrhage in Norway between 2008 and 2015

The role and therapeutic potential of heat shock proteins in haemorrhagic stroke

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