Abstract

Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021

GBDGlobal Subarachnoid Hemorrhage Risk Factors Collaborators 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 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 Arnlov 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 Barnighausen TW Barqawi HJ Barua L Bastan MM 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 Camera LA Campos LA Campos-Nonato I Capodici A Carvalho F Castaneda-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 DT Chung SC 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-Gongora V Debopadhaya S Delgado-Enciso I Dervisevic 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 A R 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 SY 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 HH Hwang BF 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 Jurisson 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 Kivimaki M Kolahi AA Kompani F Korzh O Kostev K Kothari N Krishan K Krishna V Krishnamoorthy V Kuddus M Kulimbet M Kunutsor SK Kurniasari MD Kusuma D Kyto 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 WC Lee YH Lenzi J Leonardi M Li MC Li X Lim SS Lin J Liu X Lohner V Lorenzovici L Lotufo PA Lucchetti G Lusk JB Lutzky Saute R MAmin 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 Sa 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 Sa 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 AMp 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 MM 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 SA Tabche C Taiba J Talaat IM Tamuzi JL Tan KK Temsah MH 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 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 Villafane 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 Zanghi A Zare I Zastrozhin M Zhang C Zhang Y Zhang ZJ Zhang Z Zhao H Zhou SC Zhumagaliuly A Zia H Zielinska M Zyoud SH Roth GA Feigin VL
JAMA Neurol. 2025;82765-87

Permenent descriptor

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 10ÔÇ»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.