Global Burden of Intracerebral Hemorrhage, 1990-2021, and Projections to 2050: A Global Burden of Disease Study 2021.

BACKGROUND:Despite resulting in significant mortality and long-term disability, research on the burden of intracerebral hemorrhage (ICH) remains insufficient. Therefore, this study estimated the global burden of ICH and projected changes in the disease burden through 2050 under scenarios of improved risk factor profiles. METHODS:The burden of ICH was estimated using data from the Global Burden of Disease Study 2021, based on incidence, mortality, and disability-adjusted life years (DALYs), and was stratified by region, age, year, sex, and Socio-demographic Index (SDI) level. In addition, we conducted an attribution analysis of the ICH burden, focusing on behavioral (including dietary risks and tobacco) and metabolic risk factors, and developed scenario-based projections through 2050 to estimate the potential impact of improved risk management. RESULTS:In 2021, a total of 3,444.34 thousand incident cases (95% uncertainty interval [UI], 3,053.01-3,812.04) of ICH were reported worldwide, along with 3,308.37 thousand deaths (3,021.08-3,594.72) attributable to ICH. Males exhibited a higher disease burden, with an age-standardized incidence rate (ASIR) per 100,000 population of 48.71 (95% UI, 43.07-54.27), compared to 33.61 (29.47-37.22) in females. The burden progressively increased with age, with notably higher mortality observed among individuals aged ≥ 65 years. There were substantial disparities in the ASIR by SDI level, with high SDI countries showing the lowest rates at 16.30 per 100,000 population (95% UI, 14.51-18.02), compared to 57.83 (51.95-63.27) in low SDI countries. Among behavioral and metabolic risk factors, high systolic blood pressure and smoking were identified as the leading modifiable risk factors for ICH. Forecasts based on the improved behavioral and metabolic risk scenario project a reduction in the age-standardized DALY rate to 166.13 per 100,000 population (95% UI, 132.31-209.64) by 2050, compared to 599.04 (482.89-744.16) projected under the baseline scenario. CONCLUSION:Although the global burden of ICH has declined, it remains a major concern in several regions. Projections through 2050 suggest that improvements in the behavioral and metabolic risk profiles could substantially reduce the future burden of ICH, emphasizing the importance of targeted strategies to support evidence-based public health policy.