Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)

Drescher, Conrad; Buchwald, Fredrik; Ullberg, Teresa; Pihlsgård, Mats; Norrving, Bo; Petersson, Jesper

Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)

Mark

Drescher, Conrad ^LU ; Buchwald, Fredrik ^LU ; Ullberg, Teresa ^LU ; Pihlsgård, Mats ^LU ; Norrving, Bo ^LU and Petersson, Jesper ^LU (2023) In Neuroepidemiology 57(6). p.367-376

Abstract: Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010-2012, 2013-2016, and 2017-2019. Incidence rates are shown as crude and... (More); Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010-2012, 2013-2016, and 2017-2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8-30.3) to 26.7 (95% CI 26.0-27.3) between 2010-2012 and 2017-2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0-26.3) to 20.7 (95% CI 20.1-21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61-4.12) to 6.01 (95% CI 5.70-6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010-2012 and 2017-2019 from 13.1% to 22.5% (p < 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146-164) to 106 (95% CI 98.6-113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1-29.4) to 65.5 (95% CI 59.9-71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.
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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/b9831651-1982-4fa4-97d0-af486183cfe4

author

Drescher, Conrad ^LU ; Buchwald, Fredrik ^LU ; Ullberg, Teresa ^LU ; Pihlsgård, Mats ^LU ; Norrving, Bo ^LU and Petersson, Jesper ^LU

organization

publishing date

2023-12

type

Contribution to journal

publication status

published

subject

Neurology

keywords

Incidence, Intracerebral hemorrhage, Oral anticoagulants, Registry study, Sweden

in

Neuroepidemiology

volume

57

issue

6

pages

10 pages

publisher

Karger

external identifiers

pmid:37619536
scopus:85180405273

ISSN

0251-5350

DOI

10.1159/000533751

language

English

LU publication?

yes

id

b9831651-1982-4fa4-97d0-af486183cfe4

date added to LUP

2024-01-10 11:43:43

date last changed

2024-04-25 07:40:59

@article{b9831651-1982-4fa4-97d0-af486183cfe4,
  abstract     = {{<p>Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010-2012, 2013-2016, and 2017-2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8-30.3) to 26.7 (95% CI 26.0-27.3) between 2010-2012 and 2017-2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0-26.3) to 20.7 (95% CI 20.1-21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61-4.12) to 6.01 (95% CI 5.70-6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010-2012 and 2017-2019 from 13.1% to 22.5% (p &lt; 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146-164) to 106 (95% CI 98.6-113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1-29.4) to 65.5 (95% CI 59.9-71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.</p>}},
  author       = {{Drescher, Conrad and Buchwald, Fredrik and Ullberg, Teresa and Pihlsgård, Mats and Norrving, Bo and Petersson, Jesper}},
  issn         = {{0251-5350}},
  keywords     = {{Incidence; Intracerebral hemorrhage; Oral anticoagulants; Registry study; Sweden}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{367--376}},
  publisher    = {{Karger}},
  series       = {{Neuroepidemiology}},
  title        = {{Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)}},
  url          = {{http://dx.doi.org/10.1159/000533751}},
  doi          = {{10.1159/000533751}},
  volume       = {{57}},
  year         = {{2023}},
}

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Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)