Liu Xuanchen, Cheng Rui, Song Yingda, Yang Xiaoxiong, Niu Xiaochen, Wang Chunhong, Jia Guijun, Ji Hongming
The Neurosurgery Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China.
The Neurosurgery Department of Shanxi Provincial People's Hospital, Taiyuan, Shanxi Province, China.
PLoS One. 2024 Dec 20;19(12):e0316111. doi: 10.1371/journal.pone.0316111. eCollection 2024.
This study aims to analyze the global burden of subarachnoid hemorrhage (SAH) among adolescents and young adults (AYAs) aged 15-39 years from 1990 to 2021, highlighting spatial and temporal trends and providing insights for future public health strategies.
Data were collected from the Global Burden of Disease Study 2021 (GBD 2021), which includes comprehensive evaluations of health conditions and associated risk factors across 204 countries and territories. The focus was on SAH incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among AYAs. The data were segmented by age groups (15-19, 20-24, 25-29, 30-34, 35-39 years) and socio-demographic index (SDI) quintiles. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to assess temporal trends and the impact of population growth, aging, and epidemiological changes.
From 1990 to 2021, the global number of SAH incident cases among AYAs increased by 12.6%, from 109,120 cases in 1990 to 122,822 cases in 2021. Prevalent cases rose by 17.1%, from 1,212,170 cases in 1990 to 1,419,127 cases in 2021. Conversely, the number of deaths decreased by approximately 26.6%, from 30,348 cases in 1990 to 22,266 cases in 2021. Similarly, DALYs decreased by 23.7%, from 1,996,041 cases in 1990 to 1,523,328 cases in 2021. Notably, over these thirty years, the age-standardized rates (ASR) of incidence, prevalence, mortality, and DALYs for the AYA population showed an overall decreasing trend, despite fluctuations in specific periods. The age-standardized mortality rate (ASMR) and age-standardized DALYs (ASR for DALYs) decreased continuously with an average annual percentage change (AAPC) of -2.2% (95% CI: -2.36, -2.04) and -2.02% (95% CI: -2.17, -1.88), respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) had an AAPC of -0.8% (95% CI: -0.85, -0.75) and -0.65% (95% CI: -0.66, -0.64), respectively. Particularly, the ASIR showed a continuous decline from 1990 to 2015, followed by a slight increase from 2014 to 2019 (APC: 0.14%, 95% CI: 0.03, 0.25), and accelerated growth from 2019 to 2021 (APC: 1.23%, 95% CI: 0.88, 1.57). The ASPR declined from 1990 to 2019, followed by an increase from 2019 to 2021 (APC: 0.15%, 95% CI: 0.05, 0.25). Regional analysis revealed substantial burdens in the Middle-SDI and Low-Middle-SDI regions, with the Middle-SDI region having the highest incidence, prevalence, mortality, and DALYs. Decomposition analysis indicated that population growth was the primary driver of increased SAH cases, while epidemiological changes contributed significantly to the decline in deaths and DALYs.
The findings underscore the need for targeted public health interventions, particularly in low and low-middle-SDI regions, to reduce the burden of SAH among AYAs. Improved healthcare resources, enhanced health education, and preventive strategies are crucial. This study provides valuable data to inform future public health policies and resource allocation, emphasizing the importance of addressing the unique challenges faced by AYAs.
本研究旨在分析1990年至2021年期间15至39岁青少年和青年（AYA）蛛网膜下腔出血（SAH）的全球负担，突出时空趋势，并为未来公共卫生策略提供见解。
数据收集自《2021年全球疾病负担研究》（GBD 2021），该研究对204个国家和地区的健康状况及相关风险因素进行了全面评估。重点关注AYA人群中的SAH发病率、患病率、死亡率和伤残调整生命年（DALY）。数据按年龄组（15 - 19岁、20 - 24岁、25 - 29岁、30 - 34岁、35 - 39岁）和社会人口指数（SDI）五分位数进行划分。采用统计分析方法，包括Joinpoint回归分析和分解分析，以评估时间趋势以及人口增长、老龄化和流行病学变化的影响。
1990年至2021年期间，AYA人群中SAH的全球发病病例数增加了12.6%，从1990年的109,120例增至2021年的122,822例。患病病例数增加了17.1%，从1990年的1,212,170例增至2021年的1,419,127例。相反，死亡人数减少了约26.6%，从1990年的30,348例降至2021年的22,266例。同样，DALY减少了23.7%，从1990年的1,996,041例降至2021年的1,523,328例。值得注意的是，在这三十年中，AYA人群的发病率、患病率、死亡率和DALY的年龄标准化率（ASR）总体呈下降趋势，尽管在特定时期有所波动。年龄标准化死亡率（ASMR）和年龄标准化DALY（DALY的ASR）持续下降，平均年百分比变化（AAPC）分别为 - 2.2%（95% CI： - 2.36， - 2.04）和 - 2.02%（95% CI： - 2.17， - 1.88）。年龄标准化发病率（ASIR）和年龄标准化患病率（ASPR）的AAPC分别为 - 0.8%（95% CI： - 0.85， - 0.75）和 - 0.65%（95% CI： - 0.66， - 0.64）。特别是，ASIR在1990年至2015年期间持续下降，随后在2014年至2019年期间略有上升（APC：0.14%，95% CI：0.03，0.25），并在2019年至2021年期间加速增长（APC：1.23%，95% CI：0.88，1.57）。ASPR在1990年至2019年期间下降，随后在2019年至2021年期间上升（APC：0.15%，95% CI：0.05，0.25）。区域分析显示，中SDI和低中SDI地区负担较重，中SDI地区的发病率、患病率、死亡率和DALY最高。分解分析表明，人口增长是SAH病例增加的主要驱动因素，而流行病学变化对死亡人数和DALY的下降贡献显著。
研究结果强调了针对性公共卫生干预措施的必要性，特别是在低和低中SDI地区，以减轻AYA人群中SAH的负担。改善医疗资源、加强健康教育和预防策略至关重要。本研究提供了有价值的数据，为未来公共卫生政策和资源分配提供参考，强调了应对AYA人群面临的独特挑战的重要性。
