McCandless Martin G, Dharia Anand A, Wicks Elizabeth E, Camarata Paul J
Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States.
Division of Neurosurgery, University of Vermont Medical Center, Burlington, VT, United States.
Front Neurol. 2024 Aug 14;15:1385128. doi: 10.3389/fneur.2024.1385128. eCollection 2024.
Nontraumatic subarachnoid hemorrhage (ntSAH) often results from a ruptured aneurysm and correlates with significant morbidity and mortality, particularly among the older population. Despite its impact, limited comprehensive studies evaluate the longitudinal trends in ntSAH-related mortality in older adults in the United States (US).
The authors conducted a retrospective analysis using the CDC WONDER database from 1999 to 2020, analyzing Multiple Cause-of-Death Public Use death certificates to identify ntSAH as a contributing factor in the death of adults aged 65 years and older. We calculated age-adjusted mortality rates (AAMR) and annual percent change (APC) to examine trends across demographic variables such as sex, race/ethnicity, urbanization, and states/census region.
A total of 78,260 ntSAH-related deaths (AAMR 8.50 per 100,000 individuals) occurred among older adults in the US from 1999 to 2020. The overall AAMR for ntSAH decreased from 9.98 in 1999 to 8.67 in 2020 with an APC of -0.7% [95% CI (-1.0, -0.3)]. However, the authors observed a noticeable rise from 2013 to 2020 with an APC of 1.7% [95% CI (0.8, 2.6)]. Sex, racial, and regional disparities were evident with higher mortality rates for ages 85 or greater (crude mortality rate 16.6), women (AAMR 9.55), non-Hispanic Asian or Pacific Islander (AAMR 12.5), and micropolitan areas (AAMR 8.99), and Western US (AAMR 8.65).
Mortality from ntSAH increases with age, affects women disproportionately, and occurs more often in an inpatient setting. These findings necessitate targeted, multi-dimensional health policies and clinical interventions. Specialties beyond neurosurgery can utilize this data for improved risk stratification and early treatment. Policymakers should focus on equitable resource allocation and community-level interventions to mitigate these trends effectively.
非创伤性蛛网膜下腔出血（ntSAH）通常由动脉瘤破裂引起，与显著的发病率和死亡率相关，尤其是在老年人群中。尽管其影响重大，但在美国，针对老年人ntSAH相关死亡率的纵向趋势进行的全面研究有限。
作者使用疾病控制与预防中心（CDC）的WONDER数据库进行了一项回顾性分析，时间跨度为1999年至2020年，分析多死因公共使用死亡证明，以确定ntSAH是否为65岁及以上成年人死亡的一个促成因素。我们计算了年龄调整死亡率（AAMR）和年变化百分比（APC），以研究性别、种族/族裔、城市化程度以及州/人口普查区域等人口统计学变量的趋势。
1999年至2020年期间，美国老年人中共有78260例与ntSAH相关的死亡（AAMR为每10万人8.50例）。ntSAH的总体AAMR从1999年的9.98降至2020年的8.67，APC为-0.7% [95%置信区间（-1.0，-0.3）]。然而，作者观察到2013年至2020年有明显上升，APC为1.7% [95%置信区间（0.8，2.6）]。性别、种族和地区差异明显，85岁及以上人群（粗死亡率16.6）、女性（AAMR 9.55）、非西班牙裔亚裔或太平洋岛民（AAMR 12.5）、微都市地区（AAMR 8.99）以及美国西部（AAMR 8.65）的死亡率较高。
ntSAH导致的死亡率随年龄增长而增加，对女性的影响尤为严重，且更多发生在住院环境中。这些发现需要有针对性的、多维度的健康政策和临床干预措施。神经外科以外的专业领域可以利用这些数据来改进风险分层和早期治疗。政策制定者应专注于公平的资源分配和社区层面的干预措施，以有效缓解这些趋势。
