Key result
The adjusted odds of 30-day mortality following subarachnoid hemorrhage in 2005 compared to 1986 was significantly reduced (OR 0.64) for patients under 70 years of age.
Cohort (n=12,056)
Yes
Odds Ratio: 0.64 (95% CI 0.54–0.76)
p-value: p=<0.001
Between 1986 and 2005 in Scotland, the incidence of subarachnoid haemorrhage remained stable, but 30-day case fatality declined substantially, particularly in middle-aged patients.
Declining 30-day SAH mortality in patients under 70; extends temporal trends but leaves open drivers of improvement.
BACKGROUND: To examine age and sex specific incidence and 30 day case fatality for subarachnoid haemorrhage (SAH) in Scotland over a 20 year period. METHODS: A retrospective cohort study using routine hospital discharge data linked to death records. RESULTS: Between 1986 and 2005, 12,056 individuals experienced an incident SAH. Of these 10,113 (84%) survived to reach hospital. Overall age-standardised incidence rates were greater in women than men and remained relatively stable over the study period. In 2005, incidence in women was 12.8 (95% CI 11.5 to 14.2) and in men 7.9 (95% CI 6.9 to 9.1). 30 day case fatality in individuals hospitalised with SAH declined substantially, falling from 30.0% in men and 33.9% in women in 1986-1990 to 24.5% in men and 29.1% in women in 2001-2005. For both men and women, the largest reductions were observed in those aged between 40 to 59 years. After adjustment for age, socio-economic status and co-morbidity, the odds of death at 30 days in 2005 compared to odds of death in 1986 was 0.64 (0.54 to 0.76), p < 0.001 for those below 70 years, and 1.14 (0.83 to 1.56), p = 0.4 in those 70 years and above. CONCLUSIONS: Incidence rates for SAH remained stable between 1986 and 2005 suggesting that a better understanding of SAH risk factors and their reduction is needed. 30 day case fatality rates have declined substantially, particularly in middle-age. However, they remain high and it is important to ensure that this is not due to under-diagnosis or under-treatment.
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Macpherson et al. (2011) conducted a cohort in Subarachnoid haemorrhage (n=12,056). Year of incidence (2005) vs. Year of incidence (1986) was evaluated on Odds of death at 30 days in 2005 compared to 1986 for patients below 70 years (OR 0.64, 95% CI 0.54 to 0.76, p=<0.001). The adjusted odds of 30-day mortality following subarachnoid hemorrhage in 2005 compared to 1986 was significantly reduced (OR 0.64) for patients under 70 years of age.
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