Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage
Authors: Ilari Rautalin, Victor Volovici, Benjamin A. Stark, Catherine O. Johnson, Jaakko Kaprio, Miikka Korja, Rita V. Krishnamurthi, Balakrishnan Sukumaran Nair, Annemarei Ranta, Gabriel J. E. Rinkel, Mervyn D. I. Vergouwen, Yohannes Habtegiorgis Abate, Hedayat Abbastabar, Foad Abd-Allah, Atef Abdelkader, Parsa Abdi, Arash Abdollahi, Auwal Abdullahi, Olugbenga Olusola Abiodun, Richard Gyan Aboagye, Mohamed Abouzid, Dariush Abtahi, Samir Abu Rumeileh, Ahmed Abualhasan, Hasan Abualruz, Hana J. Abukhadijah, Ahmed Abu-Zaid, Lawan Hassan Adamu, Isaac Yeboah Addo, Rufus Adesoji Adedoyin, Oyelola A. Adegboye, Saryia Adra, Leticia Akua Adzigbli, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Aqeel Ahmad, Danish Ahmad, Amir Mahmoud Ahmadzade, Ali Ahmed, Haroon Ahmed, Syed Anees Ahmed, Budi Aji, Mohammed Ahmed Akkaif, Yazan Al-Ajlouni, Ziyad Al-Aly, Mohammed Albashtawy, Mohammed Usman Ali, Sheikh Mohammad Alif, Yousef Alimohamadi, Syed Mohamed Aljunid, Mahmoud A. Alomari, Ahmad Alrawashdeh, Mohammed A. Alsabri, Rustam Al-Shahi Salman, Awais Altaf, Alaa B. Al-Tammemi, Nelson Alvis-Guzman, Hassan Alwafi, Mohammad Al-Wardat, Yaser Mohammed Al-Worafi, Hany Aly, Mohammad Sharif Ibrahim Alyahya, Karem H. Alzoubi, Reza Amani, Tarek Tawfik Amin, Alireza Amindarolzarbi, Ganiyu Adeniyi Amusa, Deanna Anderlini, Dhanalakshmi Angappan, Abhishek Anil, Boluwatife Stephen Anuoluwa, Saleha Anwar, Anayochukwu Edward Anyasodor, Geminn Louis Carace Apostol, Jalal Arabloo, Demelash Areda, Johan Ärnlöv, Anton A. Artamonov, Kurnia Dwi Artanti, Ashokan Arumugam, Zahra Aryan, Mohammad Asghari-Jafarabadi, Mubarek Yesse Ashemo, Tahira Ashraf, Mohammad Athar, Seyyed Shamsadin Athari, Avinash Aujayeb, Adedapo Wasiu Awotidebe, Sina Azadnajafabad, Shahkaar Aziz, Ahmed Y. Azzam, Giridhara Rathnaiah Babu, Nasser Bagheri, Pegah Bahrami Taghanaki, Saeed Bahramian, Ruhai Bai, Atif Amin Baig, Abdulaziz T. Bako, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Mainak Bardhan, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Lingkan Barua, Mohammad-Mahdi Bastan, Sanjay Basu, Shelly L. Bell, Isabela M. Bensenor, Alemshet Yirga Berhie, Kebede A. Beyene, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Ajay Nagesh Bhat, Vivek Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Ali Bijani, Boris Bikbov, Mekuriaw Mesfin Birhan, Mulugeta M. Birhanu, Veera R. Bitra, Archith Boloor, Hamed Borhany, Susanne Breitner, Hermann Brenner, Raffaele Bugiardini, Norma B. Bulamu, Zahid A. Butt, Lucas Scotta Cabral, Florentino Luciano Caetano dos Santos, Daniela Calina, Luis Alberto Cámera, Luciana Aparecida Campos, Ismael Campos-Nonato, Angelo Capodici, Felix Carvalho, Carlos A. Castañeda-Orjuela, Alberico L. Catapano, Luca Cegolon, Joshua Chadwick, Chiranjib Chakraborty, Promit Ananyo Chakraborty, Sandip Chakraborty, Rama Mohan Chandika, Gashaw Sisay Chanie, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Gerald Chi, Fatemeh Chichagi, Patrick R. Ching, Hitesh Chopra, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Sheng-Chia Chung, Alyssa Columbus, Michael H. Criqui, Alanna Gomes da Silva, Mohammad Amin Dabbagh Ohadi, Omid Dadras, Xiaochen Dai, Koustuv Dalal, Lachlan L. Dalli, Emanuele D’Amico, Mohsen Dashti, Kairat Davletov, Vanessa De la Cruz-Góngora, Shayom Debopadhaya, Ivan Delgado-Enciso, Emina Dervišević, Vinoth Gnana Chellaiyan Devanbu, Syed Masudur Rahman Dewan, Amol S. Dhane, Mahmoud Dibas, Thanh Chi Do, Thao Huynh Phuong Do, Sushil Dohare, Mohamed Fahmy Doheim, Klara Georgieva Dokova, Deepa Dongarwar, Mario D’Oria, Ojas Prakashbhai Doshi, Rajkumar Prakashbhai Doshi, Robert Kokou Dowou, Haneil Larson Dsouza, Siddhartha Dutta, Arkadiusz Marian Dziedzic, Abdel Rahman E’mar, David Edvardsson, Defi Efendi, Ferry Efendi, Nevine El Nahas, Islam Y. Elgendy, Muhammed Elhadi, Chadi Eltaha, Mohd. Elmagzoub Eltahir, Theophilus I. Emeto, Natalia Fabin, Adeniyi Francis Fagbamigbe, Ayesha Fahim, Ildar Ravisovich Fakhradiyev, Jawad Fares, Pawan Sirwan Faris, Nelsensius Klau Fauk, Timur Fazylov, Ginenus Fekadu, Nuno Ferreira, Getahun Fetensa, Florian Fischer, Matteo Foschi, Ni Kadek Yuni Fridayani, Abduzhappar Gaipov, Avi A. Gajjar, Aravind P. Gandhi, Balasankar Ganesan, Ravindra Kumar Garg, Miglas Welay Gebregergis, Mesfin Gebrehiwot, Teferi Gebru Gebremeskel, Molla Getie, Delaram J. Ghadimi, Fataneh Ghadirian, Sulmaz Ghahramani, Afsaneh Ghasemzadeh, Ramy Mohamed Ghazy, Maryam Gholamalizadeh, Sherief Ghozy, Artyom Urievich Gil, Jaleed Ahmed Gilani, Elena V. Gnedovskaya, Pouya Goleij, Alessandra C. Goulart, Barbara Niegia Garcia Goulart, Shi-Yang Guan, Sapna Gupta, Farrokh Habibzadeh, Mostafa Hadei, Najah R. Hadi, Samer Hamidi, Nasrin Hanifi, Graeme J. Hankey, Netanja I. Harlianto, Josep Maria Haro, Faizul Hasan, Hamidreza Hasani, Md Saquib Hasnain, Mahgol Sadat Hassan Zadeh Tabatabaei, Johannes Haubold, Rasmus J. Havmoeller, Simon I. Hay, Youssef Hbid, Golnaz Heidari, Mohammad Heidari, Mehdi Hemmati, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla, Mehdi Hosseinzadeh, Sorin Hostiuc, Junjie Huang, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Nayu Ikeda, Adalia Ikiroma, Mehran Ilaghi, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Md. Rabiul Islam, Nahlah Elkudssiah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Louis Jacob, Abdollah Jafarzadeh, Akhil Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Abubakar Ibrahim Jatau, Talha Jawaid, Sathish Kumar Jayapal, Jost B. Jonas, Nitin Joseph, Mikk Jürisson, Vidya Kadashetti, Rizwan Kalani, Vineet Kumar Kamal, Arun Kamireddy, Tanuj Kanchan, Himal Kandel, Jafar Karami, Ibraheem M. Karaye, Yeganeh Karimi, Arman Karimi Behnagh, Faizan Zaffar Kashoo, Gbenga A. Kayode, Foad Kazemi, Emmanuelle Kesse-Guyot, Yousef Saleh Khader, Inn Kynn Khaing, Fayaz Khan, Mohammad Jobair Khan, Haitham Khatatbeh, Moawiah Mohammad Khatatbeh, Hamid Reza Khayat Kashani, Khalid A. Kheirallah, Feriha Fatima Khidri, Moein Khormali, Atulya Aman Khosla, Kwanghyun Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Mika Kivimäki, Ali-Asghar Kolahi, Farzad Kompani, Oleksii Korzh, Karel Kostev, Nikhil Kothari, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Mohammed Kuddus, Mukhtar Kulimbet, Setor K. Kunutsor, Maria Dyah Kurniasari, Dian Kusuma, Ville Kytö, Carlo La Vecchia, Chandrakant Lahariya, Daphne Teck Ching Lai, Hanpeng Lai, Tri Laksono, Tea Lallukka, Kamaluddin Latief, Kaveh Latifinaibin, Nhi Huu Hanh Le, Thao Thi Thu Le, Munjae Lee, Seung Won Lee, Wei-Chen Lee, Yo Han Lee, Jacopo Lenzi, Matilde Leonardi, Ming-Chieh Li, Xiaopan Li, Stephen S. Lim, Jialing Lin, Xuefeng Liu, Valerie Lohner, László Lorenzovici, Paulo A. Lotufo, Giancarlo Lucchetti, Jay B. Lusk, Ricardo Lutzky Saute, Hawraz Ibrahim M. Amin, Armaan K. Malhotra, Kashish Malhotra, Ahmad Azam Malik, Deborah Carvalho Malta, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Emmanuel Manu, Hamid Reza Marateb, Mirko Marino, Seyed Farzad Maroufi, Ramon Martinez-Piedra, Santi Martini, Miquel Martorell, Roy Rillera Marzo, Yasith Mathangasinghe, Elezebeth Mathews, Andrea Maugeri, Steven M. McPhail, Asim Mehmood, Man Mohan Mehndiratta, Kamran Mehrabani-Zeinabad, Ritesh G. Menezes, Sultan Ayoub Meo, Atte Meretoja, Tomislav Mestrovic, Chamila Dinushi Kukulege Mettananda, Tomasz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Giuseppe Minervini, Le Huu Nhat Minh, Andreea Mirica, Erkin M. Mirrakhimov, Mohammad Mirza-Aghazadeh-Attari, Ajay Kumar Mishra, Prasanna Mithra, Abdalla Z. Mohamed, Ahmed Ismail Mohamed, Ameen Mosa Mohammad, Soheil Mohammadi, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Ali H. Mokdad, Sabrina Molinaro, Shaher Momani, Mohammad Ali Moni, AmirAli Moodi Ghalibaf, Maryam Moradi, Yousef Moradi, Paula Moraga, Lidia Morawska, Ahmed Msherghi, Kavita Munjal, Christopher J. L. Murray, Ahamarshan Jayaraman Nagarajan, Ganesh R. Naik, Soroush Najdaghi, Noureddin Nakhostin Ansari, Shumaila Nargus, Delaram Narimani Davani, Zuhair S. Natto, Javaid Nauman, Vinod C. Nayak, Athare Nazri-Panjaki, Ruxandra Irina Negoi, Soroush Nematollahi, Charles Richard James Newton, Duc Hoang Nguyen, Hau Thi Hien Nguyen, Hien Quang Nguyen, Phat Tuan Nguyen, Van Thanh Nguyen, Robina Khan Niazi, Yeshambel T. Nigatu, Ali Nikoobar, Antonio Tolentino Nogueira de Sá, Shuhei Nomura, Jean Jacques Noubiap, Fred Nugen, Chimezie Igwegbe Nzoputam, Bogdan Oancea, Michael Safo Oduro, Tolulope R. Ojo-Akosile, Hassan Okati-Aliabad, Sylvester Reuben Okeke, Akinkunmi Paul Okekunle, Andrew T. Olagunju, Muideen Tunbosun Olaiya, Arão Belitardo Oliveira, Gláucia Maria Moraes Oliveira, Abdulhakeem Abayomi Olorukooba, Isaac Iyinoluwa Olufadewa, Raffaele Ornello, Esteban Ortiz-Prado, Uchechukwu Levi Osuagwu, Amel Ouyahia, Mayowa O. Owolabi, Ahmad Ozair, Mahesh Padukudru P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Demosthenes Panagiotakos, Georgios D. Panos, Leonidas D. Panos, Ioannis Pantazopoulos, Romil R. Parikh, Seoyeon Park, Jay Patel, Urvish K. Patel, Dimitrios Patoulias, Paolo Pedersini, Emmanuel K. Peprah, Gavin Pereira, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Fanny Emily Petermann-Rocha, Anil K. Philip, Michael A. Piradov, Evgenii Plotnikov, Roman V. Polibin, Maarten J. Postma, Jalandhar Pradhan, Manya Prasad, Jagadeesh Puvvula, Nameer Hashim Qasim, Gangzhen Qian, Alberto Raggi, Fakher Rahim, Vafa Rahimi-Movaghar, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Sathish Rajaa, Ali Rajabpour Sanati, Pushp Lata Rajpoot, Prashant Rajput, Mahmoud Mohammed Ramadan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Amey Rane, Sina Rashedi, Mohammad-Mahdi Rashidi, Devarajan Rathish, Salman Rawaf, Christian Razo, Murali Mohan Rama Krishna Reddy, Elrashdy Redwan, Giuseppe Remuzzi, Nazila Rezaei, Negar Rezaei, Mohsen Rezaeian, Hermano Alexandre Lima Rocha, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Michele Romoli, Marina Romozzi, Allen Guy Ross, Himanshu Sekhar Rout, Nitai Roy, Priyanka Roy, Aly M. A. Saad, Zahra Saadatian, Siamak Sabour, Simona Sacco, Basema Ahmad Saddik, Erfan Sadeghi, Usman Saeed, Fatemeh Saheb Sharif-Askari, Amirhossein Sahebkar, Pragyan Monalisa Sahoo, Md Refat Uz Zaman Sajib, Luciane B. Salaroli, Mohamed A. Saleh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M. Samy, Milena M. Santric-Milicevic, Aswini Saravanan, Tanmay Sarkar, Gargi Sachin Sarode, Sachin C. Sarode, Benn Sartorius, Maheswar Satpathy, Markus P. Schlaich, Ione Jayce Ceola Schneider, Art Schuermans, Siddharthan Selvaraj, Subramanian Senthilkumaran, Sadaf G. Sepanlou, Yashendra Sethi, Allen Seylani, Ahmed Nabil Shaaban, Mahan Shafie, Moyad Jamal Shahwan, Masood Ali Shaikh, Summaiya Zareen Shaikh, Muhammad Aaqib Shamim, Anas Shamsi, Alfiya Shamsutdinova, Mohd Shanawaz, Mohammed Shannawaz, Amin Sharifan, Javad Sharifi Rad, Vishal Sharma, Bereket Beyene Shashamo, Mahabalesh Shetty, Premalatha K. Shetty, Mika Shigematsu, Aminu Shittu, Ivy Shiue, Nathan A. Shlobin, Seyed Afshin Shorofi, Emmanuel Edwar Siddig, Baljinder Singh, Paramdeep Singh, Puneetpal Singh, Surjit Singh, Farrukh Sobia, Ranjan Solanki, Shipra Solanki, Soroush Soraneh, Michael Spartalis, Suresh Kumar Srinivasamurthy, Jeffrey D. Stanaway, Muhammad Haroon Stanikzai, Antonina V. Starodubova, Jing Sun, Zhong Sun, Chandan Kumar Swain, Lukasz Szarpak, Payam Tabaee Damavandi, Seyyed Mohammad Tabatabaei, Seyed-Amir Tabatabaeizadeh, Celine Tabche, Jabeen Taiba, Iman M. Talaat, Jacques Lukenze Tamuzi, Ker-Kan Tan, Mohamad-Hani Temsah, Masayuki Teramoto, Ramna Thakur, Kavumpurathu Raman Thankappan, Rasiah Thayakaran, Sathish Thirunavukkarasu, Jansje Henny Vera Ticoalu, Krishna Tiwari, Marcello Tonelli, Roman Topor-Madry, Marcos Roberto Tovani-Palone, An Thien Tran, Jasmine T. Tran, Thang Huu Tran, Nguyen Tran Minh Duc, Thomas Clement Truelsen, Thien Tan Tri Tai Truyen, Daniel Hsiang-Te Tsai, Atta Ullah, Brigid Unim, Bhaskaran Unnikrishnan, Carolyn Anne Unsworth, Jibrin Sammani Usman, Sanaz Vahdati, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Jef Van den Eynde, Joe Varghese, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Dominique Vervoort, Jorge Hugo Villafañe, Manish Vinayak, Sergey Konstantinovitch Vladimirov, Hatem A. Wafa, Yasir Waheed, Waseem Wahood, Mandaras Tariku Walde, Yanzhong Wang, Nuwan Darshana Wickramasinghe, Peter Willeit, Asrat Arja Wolde, Charles D. A. Wolfe, Yihun Miskir Wubie, Hong Xiao, Suowen Xu, Xiaoyue Xu, Kazumasa Yamagishi, Yuichiro Yano, Amir Yarahmadi, Habib Yaribeygi, Sanni Yaya, Pengpeng Ye, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Aurora Zanghì, Iman Zare, Michael Zastrozhin, Chen Zhang, Yunquan Zhang, Zhi-Jiang Zhang, Zhiqiang Zhang, Hanqing Zhao, Shang Cheng Zhou, Abzal Zhumagaliuly, Hafsa Zia, Magdalena Zielińska, Samer H. Zyoud, Gregory A. Roth, Valery L. Feigin
Journal: JAMA Neurology (2025)

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.