Design of the China Epidemiology Research in Subarachnoid Haemorrhage (CHERISH) Study

Incidence and risks of subarachnoid hemorrhage in China

BACKGROUND AND PURPOSE

To determine incidence and risks of subarachnoid hemorrhage in China.

METHODS

A prospective, population-based, 1:2 matched case-control study in Baotou, Inner Mongolia (≈2 million population) in 2009-2011. Multiple variable models used to determine relative risk and population-attributable risks for exposures.

RESULTS

For a total of 226 patients (mean age, 59 years; 65% women; 434 controls), crude annual incidence (per 100 000) of subarachnoid hemorrhage was 6.2 (95% confidence intervals, 5.4-7.0); 4.3 (3.3-5.2) for men and 8.2 (6.9-9.6) for women. Compared with nonsmokers, adjusted relative risk of subarachnoid hemorrhage in current smokers was 2.31 (95% confidence interval, 1.31-4.09) but was 4.00 (1.62-9.89) in women. Population-attributable risk for smoking, hypertension, and low income were 18%, 36% and 59%, respectively.

CONCLUSIONS

The incidence of subarachnoid hemorrhage in China is slightly lower than in Western countries and is related to smoking, hypertension, and poor socioeconomic status.

Epidemiology of subarachnoid hemorrhage, patterns of management, and outcomes in China: a hospital-based multicenter prospective study

AIMS

To conduct a large-scale analysis on epidemiology, management, and outcomes of spontaneous subarachnoid hemorrhage (SAH), and to investigate the current situation of aneurysm obliteration in China.

METHODS

A multicenter prospective cohort study involving 132 hospitals throughout China from September 2007 to August 2008 was conducted. A total of 651 patients with spontaneous SAH were evaluated.

RESULTS

The most frequent type of SAH was aneurysmal SAH (77.4%), followed by uncommon causes (17.5%) and uncertain etiologies (5.1%). For aneurysmal SAH, the cumulative mortality at 28 days, 3 months, 6 months, and 12 months was 16.9%, 21.2%, 23.6%, and 24.6%, respectively. Obliteration of aneurysms, age, Hunt and Hess grade, and history of stroke affected the 12-month mortality. In multiple regression analysis, the region, type of hospital, patient's age, history of hypertension, and nonintraventricular hemorrhage impacted aneurysm obliteration.

CONCLUSION

Aneurysmal rupture is the most common cause of spontaneous SAH in China. The percentage of aneurysm obliteration is still low in China that seems to contribute to long-term mortality. With continued training of specialists, proper allocation of healthcare resources, and establishment of stroke centers, the rate of securing aneurysms is expected to rise.

Verbal autopsy for neurological diseases

Verbal autopsy is an interview-based technique to determine the cause distribution of death in a population. The use of verbal autopsy for understanding neurological diseases is crucial to burden of disease analyses in many countries, particularly in locations where civil registration systems are non-functioning or absent. We review the purposes, strengths, and weaknesses in the use of verbal autopsy for neurological diseases.