Incidence of Lobar and Non-Lobar Spontaneous Intracerebral Haemorrhage in a Predominantly Hispanic-Mestizo Population – The PISCIS Stroke Project: A Community-Based Prospective Study in Iquique, Chile

Abstract

Background: The incidence of intracerebral haemorrhage (ICH) in Hispanics is high, especially of non-lobar ICH. Our aim was to ascertain prospectively the incidence of first-ever spontaneous ICH (SICH) stratified by localisation in a Hispanic-Mestizo population of the north of Chile. Methods: Between July 2000 and June 2002 all possible cases of ICH were ascertained from multiple overlapping sources. The cases were allocated according to localisation. Those with vascular malformations or non-identifiable localisations were excluded. Results: We identified a total of 69 cases of first-ever ICH. Of these, 64 (92.7%) had SICH, of which we allocated 58 cases (84%) to non-lobar or lobar localisation. The mean age was 57.3 ± 17 years, and 62.3% of the subjects were male. The age-adjusted incidence rates were 13.8 (non-lobar) and 4.9 (lobar) per 100,000 person-years. Non-lobar SICH was more frequent in young males and lobar SICH in older women. The non-lobar-to-lobar ratio was similar to previous findings in Hispanics. Hypertension was more frequent in non-lobar SICH and in diabetes, heavy drinking and antithrombotic use in lobar SICH, but in none significantly. There was no association between localisation and prognosis. Conclusions: The incidence of non-lobar SICH was high, but lower than in most non-white populations. This lower incidence could be due to a lower population prevalence of risk factors, a higher socioeconomic level in this population, or chance.

Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies

“…Although studies of patients with ICH with prior use of antiplatelet agents are less consistent,22–26 most have shown a positive relationship with haematoma growth 23–26. Epidemiological data have also shown that ICH related both to antiplatelets and anticoagulants are more likely to be lobar 27. While our analysis is limited by the small number of patients treated with antithrombotics, the results support the hypothesis generated from observational studies that prior use of antithrombotic therapy increases the risks of greater haemorrhage in acute ICH.…”

Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013

“…Prior studies suggested the risk for intracerebral haemorrhage (ICH) to be marginally greater in men than in women. This differential risk by sex might be driven by an excess of deep haemorrhage in men, [44, 45] although it is well know that the risk of subarachnoid haemorrhage (about 5% of all HS) is much greater in women than in men. HS incidence rates are reportedly slightly higher in Eastern Asia, where ICH has historically accounted for a larger percentage of all strokes than in Western populations possibly due to the increased prevalence of hypertension.…”

The association between cerebral amyloid angiopathy and intracerebral haemorrhage: systematic review and meta-analysis

“…We aimed to take account of three potential confounding factors that should be described, and preferably controlled or adjusted for in comparisons of cases and controls: first, patient age, given the increasing CAA prevalence with age9; second, cognitive impairment (and its severity), given the greater prevalence of CAA in those with cognitive impairment than in those without dementia9 15; and third, patients' racial origins, given racial differences in the prevalence of apolipoprotein E polymorphisms which have been associated with ICH due to CAA16 17 and racial differences in the proportion of ICH in a lobar location 18…”