Mackey, JasonKhoury, Jane C.Alwell, KathleenMoomaw, Charles J.Kissela, Brett M.Flaherty, Matthew L.Adeoye, OpeoluWoo, DanielFerioli, SimonaDe Los Rios La Rosa, FelipeMartini, SharylKhatri, PoojaBroderick, Joseph P.Zuccarello, MarioKleindorfer, Dawn2018-05-102018-05-102016-11-22Mackey, J., Khoury, J. C., Alwell, K., Moomaw, C. J., Kissela, B. M., Flaherty, M. L., … Kleindorfer, D. (2016). Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. Neurology, 87(21), 2192–2197. https://doi.org/10.1212/WNL.00000000000033530028-3878https://hdl.handle.net/1805/16151Objective: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods. Results: The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8–10.7), 9.2 (7.2–11.2), 10.0 (8.0–12.0), 9.0 (7.1–10.9), and 7.7 (6.0–9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p = 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%–18%, p = 0.01; for trend), 30-day (46%–25%, p = 0.001), and 90-day (49%–29%, p = 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant. Conclusions: Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.en-USPublisher PolicyhemorrhageInternational Classification of Diseases–9intracerebral hemorrhageArticle