The global burden and future projections of intracerebral hemorrhage: An analysis of trends from 1990 to 2036.

Abstract

Objective: Intracerebral hemorrhage (ICH) is a severe stroke subtype with high global mortality and morbidity. This study quantifies the global burden and time trend of ICH from 1990 to 2021, and constructs a predictive model for 2036. We focus on health disparities to inform targeted prevention and intervention.

Methods: Utilizing Global Burden of Disease data, this study evaluated ICH incidence, prevalence, mortality, and disability-adjusted life years from 1990 to 2021. The study examined global, regional, and national levels. The estimated annual percentage change quantified trends. Frontier analysis examined variations by development. A Bayesian age-period-cohort model projected future burden. These methods provide a more comprehensive and actionable assessment than previous studies.

Results: The global burden of ICH increased substantially in absolute numbers from 1990 to 2021, with incident cases and deaths rising by 46.05% and 41.29%, respectively. In 2021, ICH caused 3,308,367 deaths [95% uncertainty interval (UI): 3,021,075-3,594,725]. However, age-standardized rates showed a consistent decline over time, with the age-standardized incidence rate was 40.83 (95% UI: 36.20-45.21) and the mortality rate was 39.09 (95% UI: 35.65-42.25) per 100,000, respectively. The burden of ICH was strongly associated with socio-demographic development. Lower Socio-demographic Index (SDI) regions bearing disproportionately higher mortality and DALY burdens. In contrast, higher SDI regions generally exhibited declining trends in age-standardized rates.

Conclusions: ICH remains a critical global public health challenge. Although the overall age-standardized burden has decreased, pronounced disparities persist, especially in less developed regions. Focused public health action, equitable resource distribution, and stronger health systems are critical to closing these gaps.