Background: This study evaluated the global burden of tobacco-attributable intracerebral hemorrhage (ICH) from 1990 to 2021, focusing on temporal trends, geographical disparities, and socio-demographic inequalities. Methods: We calculated the estimated annual percentage change (EAPC) of age-standardized mortality rate (ASMR) and disability-adjusted life year rate (ASDR) to assess the changing trend. An age-period-cohort (APC) model was used to assess the effects of age, period and cohort on the burden of ICH attributable to tobacco use, and the future trends till 2050 were further projected with Bayesian APC (BAPC) model. Cross-country inequalities were evaluated with the slope inequality index (SII) and the concentration index (CIx). Results: In 2021, the ASMR and ASDR of tobacco-attributable ICH were 6.56/100,000 and 179.20/100,000. From 1990 to 2021, the EAPCs were −2.08 and −2.15, respectively. The highest burden was observed in middle socio-demographic index (SDI) countries, males and Oceania. The EAPC analysis showed the fastest decline in high SDI countries (ASMR: −3.57). The burden decreased more for females than for males. The age effects on global mortality and disability-adjusted life years (DALYs) attributed to tobacco increased with age, while period and cohort effects showed a continuous downward trend. Cross-country inequalities decreased significantly, although middle SDI countries remained heavily impacted. Conclusion: Despite global progress in reducing tobacco-related ICH burden, males and middle SDI countries remain disproportionately affected. Strengthening tobacco control policies and health education for high-risk populations is essential for further reductions and health equity.
Yang et al. (Wed,) studied this question.