Ericka Samantha Teleg, MD

Bako AT, Pan A, Potter T, Tannous J, Johnson C, Baig E, Meeks J, Woo D, Vahidy FS. Contemporary Trends in the Nationwide Incidence of Primary Intracerebral Hemorrhage. Stroke. 2022.

This cross-sectional study highlights the importance of keeping track of nationwide changes in the intracerebral hemorrhage landscape based on demographic and geographic differences across the United States. While some regions globally do not have such resources to organize and structure the source of this database, this article provides a good template to do so because this is done at the national level.

The source for the data is the Nationwide Inpatient Sample (NIS), the largest publicly available all-payer in-hospital database in the United States. It represents over 90% of U.S. hospitalizations. The trend weights for pre-2012 NIS data were used to provide estimates comparable across pre- and post-2012 sample. The exclusion includes hospitalizations with concurrent diagnosis that is due to secondary intracerebral hemorrhage.

Their methodology included aggregated data by 5 consecutive 3-year time periods from 2004 to 2018. The discharge and trend weights for pre-2012 NIS to yield nationally representative estimates of time-specific ICH incidence across various age, sex, race or ethnicity and regional sub-cohorts were included. Age was categorized. Race and ethnicity, and regions included the northeast, Midwest, south and west regions of the United States.

Demonstrating ICH incidence data allows the health care system to investigate trends in ICH incidence to better structure necessary stroke prevention and treatment management. Increasing or declining incidence of primary ICH may directly or indirectly reflect control of hypertension, for example. As the authors discussed, future ICH prevention efforts should target young and middle age Americans. In terms of race, higher prevalence of uncontrolled cardiovascular risk factors is higher in other race subgroups, and this can be undermined in the overall incidence data studies. A microscopic analysis by demographic and racial representation in the overall stroke landscape, especially in underrepresented minorities, must be evaluated in such large-scale incidence studies. In terms of regional differences in ICH incidence trends, the Midwest, south, west and subregions are increasing significantly at a faster rate than the northeast. The authors have not attributed any concrete explanation for this. Perhaps, regional differences in the health care system of these regions, delivery, and behavioral practices of the sub-populations may provide some light.

Since ischemic stroke incidence and treatment is overall declining in the advent of endovascular thrombectomy technologies, intracerebral hemorrhage continues to account for 10% of all strokes, a disproportionate representative of stroke mortality. Their potential limitations include that the data likely included recurrent ICH events. This may overestimate incidence and identification of ICH rather than neuroimaging data. The conclusion of this study adds to several other ongoing national studies that aim to target primary prevention programs, especially among minority populations who experience disparate ICH burden.