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Abstract
Objective: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database.
Methods: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH and SAH using logistic regression. Cox proportional hazards regression analyses were used to estimate the risk of death during the first year of follow-up and survivors at 1 year.
Results: Case fatality after ICH was 42.0%, compared with 28.7% after SAH. It increased with age (ICH: 29.7% for 20–49 years, 54.6% for 80–89 years; SAH: 20.3% for 20–49 years, 56.7% for 80–89 years; both p-trend < 0.001), and decreased over the period 2000–2001 to 2006–2008 (ICH: from 53.1% to 35.8%, p-trend < 0.001; SAH: from 33.3% to 24.7%, p-trend = 0.02). Risk of death was significantly higher among stroke patients during the first year of follow-up compared with controls (ICH: hazard ratio [HR] 2.60, 95% confidence interval [CI] 2.09–3.24, p < 0.01; SAH: HR 2.87, 95% CI 2.07–3.97, p < 0.01) and remained elevated among survivors at 1 year (ICH: HR 2.02, 95% CI 1.75–2.32, p < 0.01; SAH: HR 1.32, 95% CI 1.02–1.69, p = 0.03).
Conclusions: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated risk of death compared with matched individuals from the general population.
GLOSSARY
- CI=
- confidence interval;
- HR=
- hazard ratio;
- ICH=
- intracerebral hemorrhage;
- PCP=
- primary care physician;
- SAH=
- subarachnoid hemorrhage;
- THIN=
- The Health Improvement Network
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
See page 566
Supplemental data at www.neurology.org
- Received September 28, 2012.
- Accepted in final form March 8, 2013.
- © 2013 American Academy of Neurology
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