Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021.
GBD 2021 Global Subarachnoid Hemorrhage Risk Factors Collaborators None., Rautalin I., Volovici V., Stark BA., Johnson CO., Kaprio J., Korja M., Krishnamurthi RV., Nair BS., Ranta A., Rinkel GJE., Vergouwen MDI., Abate YH., Abbastabar H., Abd-Allah F., Abdelkader A., Abdi P., Abdollahi A., Abdullahi A., Abiodun OO., Aboagye RG., Abouzid M., Abtahi D., Abu Rumeileh S., Abualhasan A., Abualruz H., Abukhadijah HJ., Abu-Zaid A., Adamu LH., Addo IY., Adedoyin RA., Adegboye OA., Adra S., Adzigbli LA., Agyemang-Duah W., Ahinkorah BO., Ahmad A., Ahmad D., Ahmadzade AM., Ahmed A., Ahmed H., Ahmed SA., Aji B., Akkaif MA., Al-Ajlouni Y., Al-Aly Z., Albashtawy M., Ali MU., Alif SM., Alimohamadi Y., Aljunid SM., Alomari MA., Alrawashdeh A., Alsabri MA., Salman RA-S., Altaf A., Al-Tammemi AB., Alvis-Guzman N., Alwafi H., Al-Wardat M., Al-Worafi YM., Aly H., Alyahya MSI., Alzoubi KH., Amani R., Amin TT., Amindarolzarbi A., Amusa GA., Anderlini D., Angappan D., Anil A., Anuoluwa BS., Anwar S., Anyasodor AE., Apostol GLC., Arabloo J., Areda D., Ärnlöv J., Artamonov AA., Artanti KD., Arumugam A., Aryan Z., Asghari-Jafarabadi M., Ashemo MY., Ashraf T., Athar M., Athari SS., Aujayeb A., Awotidebe AW., Azadnajafabad S., Aziz S., Azzam AY., Babu GR., Bagheri N., Bahrami Taghanaki P., Bahramian S., Bai R., Baig AA., Bako AT., Baltatu OC., Bam K., Banach M., Bandyopadhyay S., Banik B., Bardhan M., Barker-Collo SL., Bärnighausen TW., Barqawi HJ., Barua L., Bastan M-M., Basu S., Bell SL., Bensenor IM., Berhie AY., Beyene KA., Bhagavathula AS., Bhaskar S., Bhat AN., Bhat V., Bhatti GK., Bhatti JS., Bijani A., Bikbov B., Birhan MM., Birhanu MM., Bitra VR., Boloor A., Borhany H., Breitner S., Brenner H., Bugiardini R., Bulamu NB., Butt ZA., Cabral LS., Caetano Dos Santos FL., Calina D., Cámera LA., Campos LA., Campos-Nonato I., Capodici A., Carvalho F., Castañeda-Orjuela CA., Catapano AL., Cegolon L., Chadwick J., Chakraborty C., Chakraborty PA., Chakraborty S., Chandika RM., Chanie GS., Chattu VK., Chaudhary AA., Chi G., Chichagi F., Ching PR., Chopra H., Choudhari SG., Chowdhury EK., Chu D-T., Chung S-C., Columbus A., Criqui MH., da Silva AG., Dabbagh Ohadi MA., Dadras O., Dai X., Dalal K., Dalli LL., D'Amico E., Dashti M., Davletov K., De la Cruz-Góngora V., Debopadhaya S., Delgado-Enciso I., Derviševic E., Devanbu VGC., Dewan SMR., Dhane AS., Dibas M., Do TC., Do THP., Dohare S., Doheim MF., Dokova KG., Dongarwar D., D'Oria M., Doshi OP., Doshi RP., Dowou RK., Dsouza HL., Dutta S., Dziedzic AM., E'mar AR., Edvardsson D., Efendi D., Efendi F., El Nahas N., Elgendy IY., Elhadi M., Eltaha C., Eltahir ME., Emeto TI., Fabin N., Fagbamigbe AF., Fahim A., Fakhradiyev IR., Fares J., Faris PS., Fauk NK., Fazylov T., Fekadu G., Ferreira N., Fetensa G., Fischer F., Foschi M., Fridayani NKY., Gaipov A., Gajjar AA., Gandhi AP., Ganesan B., Garg RK., Gebregergis MW., Gebrehiwot M., Gebremeskel TG., Getie M., Ghadimi DJ., Ghadirian F., Ghahramani S., Ghasemzadeh A., Ghazy RM., Gholamalizadeh M., Ghozy S., Gil AU., Gilani JA., Gnedovskaya EV., Goleij P., Goulart AC., Goulart BNG., Guan S-Y., Gupta S., Habibzadeh F., Hadei M., Hadi NR., Hamidi S., Hanifi N., Hankey GJ., Harlianto NI., Haro JM., Hasan F., Hasani H., Hasnain MS., Hassan Zadeh Tabatabaei MS., Haubold J., Havmoeller RJ., Hay SI., Hbid Y., Heidari G., Heidari M., Hemmati M., Hiraike Y., Hoan NQ., Holla R., Hosseinzadeh M., Hostiuc S., Huang J., Huynh H-H., Hwang B-F., Ibitoye SE., Ikeda N., Ikiroma A., Ilaghi M., Ilesanmi OS., Ilic IM., Ilic MD., Islam MR., Ismail NE., Iso H., Isola G., Iwagami M., Jacob L., Jafarzadeh A., Jain A., Jairoun AA., Jakovljevic M., Jatau AI., Jawaid T., Jayapal SK., Jonas JB., Joseph N., Jürisson M., Kadashetti V., Kalani R., Kamal VK., Kamireddy A., Kanchan T., Kandel H., Karami J., Karaye IM., Karimi Y., Karimi Behnagh A., Kashoo FZ., Kayode GA., Kazemi F., Kesse-Guyot E., Khader YS., Khaing IK., Khan F., Khan MJ., Khatatbeh H., Khatatbeh MM., Khayat Kashani HR., Kheirallah KA., Khidri FF., Khormali M., Khosla AA., Kim K., Kim YJ., Kisa A., Kisa S., Kivimäki M., Kolahi A-A., Kompani F., Korzh O., Kostev K., Kothari N., Krishan K., Krishna V., Krishnamoorthy V., Kuddus M., Kulimbet M., Kunutsor SK., Kurniasari MD., Kusuma D., Kytö V., La Vecchia C., Lahariya C., Lai DTC., Lai H., Laksono T., Lallukka T., Latief K., Latifinaibin K., Le NHH., Le TTT., Lee M., Lee SW., Lee W-C., Lee YH., Lenzi J., Leonardi M., Li M-C., Li X., Lim SS., Lin J., Liu X., Lohner V., Lorenzovici L., Lotufo PA., Lucchetti G., Lusk JB., Lutzky Saute R., M Amin HI., Malhotra AK., Malhotra K., Malik AA., Malta DC., Mansournia MA., Mantovani LG., Manu E., Marateb HR., Marino M., Maroufi SF., Martinez-Piedra R., Martini S., Martorell M., Marzo RR., Mathangasinghe Y., Mathews E., Maugeri A., McPhail SM., Mehmood A., Mehndiratta MM., Mehrabani-Zeinabad K., Menezes RG., Meo SA., Meretoja A., Mestrovic T., Mettananda CDK., Miazgowski T., Micheletti Gomide Nogueira de Sá AC., Minervini G., Minh LHN., Mirica A., Mirrakhimov EM., Mirza-Aghazadeh-Attari M., Mishra AK., Mithra P., Mohamed AZ., Mohamed AI., Mohammad AM., Mohammadi S., Mohammadian-Hafshejani A., Mohammed S., Mokdad AH., Molinaro S., Momani S., Moni MA., Moodi Ghalibaf A., Moradi M., Moradi Y., Moraga P., Morawska L., Msherghi A., Munjal K., Murray CJL., Nagarajan AJ., Naik GR., Najdaghi S., Nakhostin Ansari N., Nargus S., Davani DN., Natto ZS., Nauman J., Nayak VC., Nazri-Panjaki A., Negoi RI., Nematollahi S., Newton CRJ., Nguyen DH., Nguyen HTH., Nguyen HQ., Nguyen PT., Nguyen VT., Niazi RK., Nigatu YT., Nikoobar A., Nogueira de Sá AT., Nomura S., Noubiap JJ., Nugen F., Nzoputam CI., Oancea B., Oduro MS., Ojo-Akosile TR., Okati-Aliabad H., Okeke SR., Okekunle AP., Olagunju AT., Olaiya MT., Oliveira AB., Oliveira GMM., Olorukooba AA., Olufadewa II., Ornello R., Ortiz-Prado E., Osuagwu UL., Ouyahia A., Owolabi MO., Ozair A., P A MP., Padron-Monedero A., Padubidri JR., Panagiotakos D., Panos GD., Panos LD., Pantazopoulos I., Parikh RR., Park S., Patel J., Patel UK., Patoulias D., Pedersini P., Peprah EK., Pereira G., Perianayagam A., Perico N., Perna S., Petermann-Rocha FE., Philip AK., Piradov MA., Plotnikov E., Polibin RV., Postma MJ., Pradhan J., Prasad M., Puvvula J., Qasim NH., Qian G., Raggi A., Rahim F., Rahimi-Movaghar V., Rahman M., Rahman MA., Rahmani AM., Rahmanian M., Rajaa S., Rajabpour Sanati A., Rajpoot PL., Rajput P., Ramadan MM., Ramasamy SK., Ramazanu S., Rane A., Rashedi S., Rashidi M-M., Rathish D., Rawaf S., Razo C., Reddy MMRK., Redwan E., Remuzzi G., Rezaei N., Rezaei N., Rezaeian M., Rocha HAL., Rodriguez JAB., Roever L., Romoli M., Romozzi M., Ross AG., Rout HS., Roy N., Roy P., Saad AMA., Saadatian Z., Sabour S., Sacco S., Saddik BA., Sadeghi E., Saeed U., Saheb Sharif-Askari F., Sahebkar A., Sahoo PM., Sajib MRUZ., Salaroli LB., Saleh MA., Samodra YL., Samuel VP., Samy AM., Santric-Milicevic MM., Saravanan A., Sarkar T., Sarode GS., Sarode SC., Sartorius B., Satpathy M., Schlaich MP., Schneider IJC., Schuermans A., Selvaraj S., Senthilkumaran S., Sepanlou SG., Sethi Y., Seylani A., Shaaban AN., Shafie M., Shahwan MJ., Shaikh MA., Shaikh SZ., Shamim MA., Shamsi A., Shamsutdinova A., Shanawaz M., Shannawaz M., Sharifan A., Sharifi Rad J., Sharma V., Shashamo BB., Shetty M., Shetty PK., Shigematsu M., Shittu A., Shiue I., Shlobin NA., Shorofi SA., Siddig EE., Singh B., Singh P., Singh P., Singh S., Sobia F., Solanki R., Solanki S., Soraneh S., Spartalis M., Srinivasamurthy SK., Stanaway JD., Stanikzai MH., Starodubova AV., Sun J., Sun Z., Swain CK., Szarpak L., Tabaee Damavandi P., Tabatabaei SM., Tabatabaeizadeh S-A., Tabche C., Taiba J., Talaat IM., Tamuzi JL., Tan K-K., Temsah M-H., Teramoto M., Thakur R., Thankappan KR., Thayakaran R., Thirunavukkarasu S., Ticoalu JHV., Tiwari K., Tonelli M., Topor-Madry R., Tovani-Palone MR., Tran AT., Tran JT., Tran TH., Tran Minh Duc N., Truelsen TC., Truyen TTTT., Tsai DH-T., Ullah A., Unim B., Unnikrishnan B., Unsworth CA., Usman JS., Vahdati S., Vaithinathan AG., Valizadeh R., Van den Eynde J., Varghese J., Vasankari TJ., Venketasubramanian N., Vervoort D., Villafañe JH., Vinayak M., Vladimirov SK., Wafa HA., Waheed Y., Wahood W., Walde MT., Wang Y., Wickramasinghe ND., Willeit P., Wolde AA., Wolfe CDA., Wubie YM., Xiao H., Xu S., Xu X., Yamagishi K., Yano Y., Yarahmadi A., Yaribeygi H., Yaya S., Ye P., Yon DK., Yonemoto N., Yu C., Zanghì A., Zare I., Zastrozhin M., Zhang C., Zhang Y., Zhang Z-J., Zhang Z., Zhao H., Zhou SC., Zhumagaliuly A., Zia H., Zielinska M., Zyoud SH., Roth GA., Feigin VL.
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.