非创伤性蛛网膜下腔出血的全球、区域和国家负担：2021年全球疾病负担研究
Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021.
作者信息
Rautalin Ilari, Volovici Victor, Stark Benjamin A, Johnson Catherine O, Kaprio Jaakko, Korja Miikka, Krishnamurthi Rita V, Nair Balakrishnan Sukumaran, Ranta Annemarei, Rinkel Gabriel J E, Vergouwen Mervyn D I, Abate Yohannes Habtegiorgis, Abbastabar Hedayat, Abd-Allah Foad, Abdelkader Atef, Abdi Parsa, Abdollahi Arash, Abdullahi Auwal, Abiodun Olugbenga Olusola, Aboagye Richard Gyan, Abouzid Mohamed, Abtahi Dariush, Abu Rumeileh Samir, Abualhasan Ahmed, Abualruz Hasan, Abukhadijah Hana J, Abu-Zaid Ahmed, Adamu Lawan Hassan, Addo Isaac Yeboah, Adedoyin Rufus Adesoji, Adegboye Oyelola A, Adra Saryia, Adzigbli Leticia Akua, Agyemang-Duah Williams, Ahinkorah Bright Opoku, Ahmad Aqeel, Ahmad Danish, Ahmadzade Amir Mahmoud, Ahmed Ali, Ahmed Haroon, Ahmed Syed Anees, Aji Budi, Akkaif Mohammed Ahmed, Al-Ajlouni Yazan, Al-Aly Ziyad, Albashtawy Mohammed, Ali Mohammed Usman, Alif Sheikh Mohammad, Alimohamadi Yousef, Aljunid Syed Mohamed, Alomari Mahmoud A, Alrawashdeh Ahmad, Alsabri Mohammed A, Salman Rustam Al-Shahi, Altaf Awais, Al-Tammemi Alaa B, Alvis-Guzman Nelson, Alwafi Hassan, Al-Wardat Mohammad, Al-Worafi Yaser Mohammed, Aly Hany, Alyahya Mohammad Sharif Ibrahim, Alzoubi Karem H, Amani Reza, Amin Tarek Tawfik, Amindarolzarbi Alireza, Amusa Ganiyu Adeniyi, Anderlini Deanna, Angappan Dhanalakshmi, Anil Abhishek, Anuoluwa Boluwatife Stephen, Anwar Saleha, Anyasodor Anayochukwu Edward, Apostol Geminn Louis Carace, Arabloo Jalal, Areda Demelash, Ärnlöv Johan, Artamonov Anton A, Artanti Kurnia Dwi, Arumugam Ashokan, Aryan Zahra, Asghari-Jafarabadi Mohammad, Ashemo Mubarek Yesse, Ashraf Tahira, Athar Mohammad, Athari Seyyed Shamsadin, Aujayeb Avinash, Awotidebe Adedapo Wasiu, Azadnajafabad Sina, Aziz Shahkaar, Azzam Ahmed Y, Babu Giridhara Rathnaiah, Bagheri Nasser, Bahrami Taghanaki Pegah, Bahramian Saeed, Bai Ruhai, Baig Atif Amin, Bako Abdulaziz T, Baltatu Ovidiu Constantin, Bam Kiran, Banach Maciej, Bandyopadhyay Soham, Banik Biswajit, Bardhan Mainak, Barker-Collo Suzanne Lyn, Bärnighausen Till Winfried, Barqawi Hiba Jawdat, Barua Lingkan, Bastan Mohammad-Mahdi, Basu Sanjay, Bell Shelly L, Bensenor Isabela M, Berhie Alemshet Yirga, Beyene Kebede A, Bhagavathula Akshaya Srikanth, Bhaskar Sonu, Bhat Ajay Nagesh, Bhat Vivek, Bhatti Gurjit Kaur, Bhatti Jasvinder Singh, Bijani Ali, Bikbov Boris, Birhan Mekuriaw Mesfin, Birhanu Mulugeta M, Bitra Veera R, Boloor Archith, Borhany Hamed, Breitner Susanne, Brenner Hermann, Bugiardini Raffaele, Bulamu Norma B, Butt Zahid A, Cabral Lucas Scotta, Caetano Dos Santos Florentino Luciano, Calina Daniela, Cámera Luis Alberto, Campos Luciana Aparecida, Campos-Nonato Ismael, Capodici Angelo, Carvalho Felix, Castañeda-Orjuela Carlos A, Catapano Alberico L, Cegolon Luca, Chadwick Joshua, Chakraborty Chiranjib, Chakraborty Promit Ananyo, Chakraborty Sandip, Chandika Rama Mohan, Chanie Gashaw Sisay, Chattu Vijay Kumar, Chaudhary Anis Ahmad, Chi Gerald, Chichagi Fatemeh, Ching Patrick R, Chopra Hitesh, Choudhari Sonali Gajanan, Chowdhury Enayet Karim, Chu Dinh-Toi, Chung Sheng-Chia, Columbus Alyssa, Criqui Michael H, da Silva Alanna Gomes, Dabbagh Ohadi Mohammad Amin, Dadras Omid, Dai Xiaochen, Dalal Koustuv, Dalli Lachlan L, D'Amico Emanuele, Dashti Mohsen, Davletov Kairat, De la Cruz-Góngora Vanessa, Debopadhaya Shayom, Delgado-Enciso Ivan, Derviševic Emina, Devanbu Vinoth Gnana Chellaiyan, Dewan Syed Masudur Rahman, Dhane Amol S, Dibas Mahmoud, Do Thanh Chi, Do Thao Huynh Phuong, Dohare Sushil, Doheim Mohamed Fahmy, Dokova Klara Georgieva, Dongarwar Deepa, D'Oria Mario, Doshi Ojas Prakashbhai, Doshi Rajkumar Prakashbhai, Dowou Robert Kokou, Dsouza Haneil Larson, Dutta Siddhartha, Dziedzic Arkadiusz Marian, E'mar Abdel Rahman, Edvardsson David, Efendi Defi, Efendi Ferry, El Nahas Nevine, Elgendy Islam Y, Elhadi Muhammed, Eltaha Chadi, Eltahir Mohd Elmagzoub, Emeto Theophilus I, Fabin Natalia, Fagbamigbe Adeniyi Francis, Fahim Ayesha, Fakhradiyev Ildar Ravisovich, Fares Jawad, Faris Pawan Sirwan, Fauk Nelsensius Klau, Fazylov Timur, Fekadu Ginenus, Ferreira Nuno, Fetensa Getahun, Fischer Florian, Foschi Matteo, Fridayani Ni Kadek Yuni, Gaipov Abduzhappar, Gajjar Avi A, Gandhi Aravind P, Ganesan Balasankar, Garg Ravindra Kumar, Gebregergis Miglas Welay, Gebrehiwot Mesfin, Gebremeskel Teferi Gebru, Getie Molla, Ghadimi Delaram J, Ghadirian Fataneh, Ghahramani Sulmaz, Ghasemzadeh Afsaneh, Ghazy Ramy Mohamed, Gholamalizadeh Maryam, Ghozy Sherief, Gil Artyom Urievich, Gilani Jaleed Ahmed, Gnedovskaya Elena V, Goleij Pouya, Goulart Alessandra C, Goulart Barbara Niegia Garcia, Guan Shi-Yang, Gupta Sapna, Habibzadeh Farrokh, Hadei Mostafa, Hadi Najah R, Hamidi Samer, Hanifi Nasrin, Hankey Graeme J, Harlianto Netanja I, Haro Josep Maria, Hasan Faizul, Hasani Hamidreza, Hasnain Md Saquib, Hassan Zadeh Tabatabaei Mahgol Sadat, Haubold Johannes, Havmoeller Rasmus J, Hay Simon I, Hbid Youssef, Heidari Golnaz, Heidari Mohammad, Hemmati Mehdi, Hiraike Yuta, Hoan Nguyen Quoc, Holla Ramesh, Hosseinzadeh Mehdi, Hostiuc Sorin, Huang Junjie, Huynh Hong-Han, Hwang Bing-Fang, Ibitoye Segun Emmanuel, Ikeda Nayu, Ikiroma Adalia, Ilaghi Mehran, Ilesanmi Olayinka Stephen, Ilic Irena M, Ilic Milena D, Islam Md Rabiul, Ismail Nahlah Elkudssiah, Iso Hiroyasu, Isola Gaetano, Iwagami Masao, Jacob Louis, Jafarzadeh Abdollah, Jain Akhil, Jairoun Ammar Abdulrahman, Jakovljevic Mihajlo, Jatau Abubakar Ibrahim, Jawaid Talha, Jayapal Sathish Kumar, Jonas Jost B, Joseph Nitin, Jürisson Mikk, Kadashetti Vidya, Kalani Rizwan, Kamal Vineet Kumar, Kamireddy Arun, Kanchan Tanuj, Kandel Himal, Karami Jafar, Karaye Ibraheem M, Karimi Yeganeh, Karimi Behnagh Arman, Kashoo Faizan Zaffar, Kayode Gbenga A, Kazemi Foad, Kesse-Guyot Emmanuelle, Khader Yousef Saleh, Khaing Inn Kynn, Khan Fayaz, Khan Mohammad Jobair, Khatatbeh Haitham, Khatatbeh Moawiah Mohammad, Khayat Kashani Hamid Reza, Kheirallah Khalid A, Khidri Feriha Fatima, Khormali Moein, Khosla Atulya Aman, Kim Kwanghyun, Kim Yun Jin, Kisa Adnan, Kisa Sezer, Kivimäki Mika, Kolahi Ali-Asghar, Kompani Farzad, Korzh Oleksii, Kostev Karel, Kothari Nikhil, Krishan Kewal, Krishna Varun, Krishnamoorthy Vijay, Kuddus Mohammed, Kulimbet Mukhtar, Kunutsor Setor K, Kurniasari Maria Dyah, Kusuma Dian, Kytö Ville, La Vecchia Carlo, Lahariya Chandrakant, Lai Daphne Teck Ching, Lai Hanpeng, Laksono Tri, Lallukka Tea, Latief Kamaluddin, Latifinaibin Kaveh, Le Nhi Huu Hanh, Le Thao Thi Thu, Lee Munjae, Lee Seung Won, Lee Wei-Chen, Lee Yo Han, Lenzi Jacopo, Leonardi Matilde, Li Ming-Chieh, Li Xiaopan, Lim Stephen S, Lin Jialing, Liu Xuefeng, Lohner Valerie, Lorenzovici László, Lotufo Paulo A, Lucchetti Giancarlo, Lusk Jay B, Lutzky Saute Ricardo, M Amin Hawraz Ibrahim, Malhotra Armaan K, Malhotra Kashish, Malik Ahmad Azam, Malta Deborah Carvalho, Mansournia Mohammad Ali, Mantovani Lorenzo Giovanni, Manu Emmanuel, Marateb Hamid Reza, Marino Mirko, Maroufi Seyed Farzad, Martinez-Piedra Ramon, Martini Santi, Martorell Miquel, Marzo Roy Rillera, Mathangasinghe Yasith, Mathews Elezebeth, Maugeri Andrea, McPhail Steven M, Mehmood Asim, Mehndiratta Man Mohan, Mehrabani-Zeinabad Kamran, Menezes Ritesh G, Meo Sultan Ayoub, Meretoja Atte, Mestrovic Tomislav, Mettananda Chamila Dinushi Kukulege, Miazgowski Tomasz, Micheletti Gomide Nogueira de Sá Ana Carolina, Minervini Giuseppe, Minh Le Huu Nhat, Mirica Andreea, Mirrakhimov Erkin M, Mirza-Aghazadeh-Attari Mohammad, Mishra Ajay Kumar, Mithra Prasanna, Mohamed Abdalla Z, Mohamed Ahmed Ismail, Mohammad Ameen Mosa, Mohammadi Soheil, Mohammadian-Hafshejani Abdollah, Mohammed Shafiu, Mokdad Ali H, Molinaro Sabrina, Momani Shaher, Moni Mohammad Ali, Moodi Ghalibaf AmirAli, Moradi Maryam, Moradi Yousef, Moraga Paula, Morawska Lidia, Msherghi Ahmed, Munjal Kavita, Murray Christopher J L, Nagarajan Ahamarshan Jayaraman, Naik Ganesh R, Najdaghi Soroush, Nakhostin Ansari Noureddin, Nargus Shumaila, Davani Delaram Narimani, Natto Zuhair S, Nauman Javaid, Nayak Vinod C, Nazri-Panjaki Athare, Negoi Ruxandra Irina, Nematollahi Soroush, Newton Charles Richard James, Nguyen Duc Hoang, Nguyen Hau Thi Hien, Nguyen Hien Quang, Nguyen Phat Tuan, Nguyen Van Thanh, Niazi Robina Khan, Nigatu Yeshambel T, Nikoobar Ali, Nogueira de Sá Antonio Tolentino, Nomura Shuhei, Noubiap Jean Jacques, Nugen Fred, Nzoputam Chimezie Igwegbe, Oancea Bogdan, Oduro Michael Safo, Ojo-Akosile Tolulope R, Okati-Aliabad Hassan, Okeke Sylvester Reuben, Okekunle Akinkunmi Paul, Olagunju Andrew T, Olaiya Muideen Tunbosun, Oliveira Arão Belitardo, Oliveira Gláucia Maria Moraes, Olorukooba Abdulhakeem Abayomi, Olufadewa Isaac Iyinoluwa, Ornello Raffaele, Ortiz-Prado Esteban, Osuagwu Uchechukwu Levi, Ouyahia Amel, Owolabi Mayowa O, Ozair Ahmad, P A Mahesh Padukudru, Padron-Monedero Alicia, Padubidri Jagadish Rao, Panagiotakos Demosthenes, Panos Georgios D, Panos Leonidas D, Pantazopoulos Ioannis, Parikh Romil R, Park Seoyeon, Patel Jay, Patel Urvish K, Patoulias Dimitrios, Pedersini Paolo, Peprah Emmanuel K, Pereira Gavin, Perianayagam Arokiasamy, Perico Norberto, Perna Simone, Petermann-Rocha Fanny Emily, Philip Anil K, Piradov Michael A, Plotnikov Evgenii, Polibin Roman V, Postma Maarten J, Pradhan Jalandhar, Prasad Manya, Puvvula Jagadeesh, Qasim Nameer Hashim, Qian Gangzhen, Raggi Alberto, Rahim Fakher, Rahimi-Movaghar Vafa, Rahman Mosiur, Rahman Muhammad Aziz, Rahmani Amir Masoud, Rahmanian Mohammad, Rajaa Sathish, Rajabpour Sanati Ali, Rajpoot Pushp Lata, Rajput Prashant, Ramadan Mahmoud Mohammed, Ramasamy Shakthi Kumaran, Ramazanu Sheena, Rane Amey, Rashedi Sina, Rashidi Mohammad-Mahdi, Rathish Devarajan, Rawaf Salman, Razo Christian, Reddy Murali Mohan Rama Krishna, Redwan Elrashdy, Remuzzi Giuseppe, Rezaei Nazila, Rezaei Negar, Rezaeian Mohsen, Rocha Hermano Alexandre Lima, Rodriguez Jefferson Antonio Buendia, Roever Leonardo, Romoli Michele, Romozzi Marina, Ross Allen Guy, Rout Himanshu Sekhar, Roy Nitai, Roy Priyanka, Saad Aly M A, Saadatian Zahra, Sabour Siamak, Sacco Simona, 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Puneetpal, Singh Surjit, Sobia Farrukh, Solanki Ranjan, Solanki Shipra, Soraneh Soroush, Spartalis Michael, Srinivasamurthy Suresh Kumar, Stanaway Jeffrey D, Stanikzai Muhammad Haroon, Starodubova Antonina V, Sun Jing, Sun Zhong, Swain Chandan Kumar, Szarpak Lukasz, Tabaee Damavandi Payam, Tabatabaei Seyyed Mohammad, Tabatabaeizadeh Seyed-Amir, Tabche Celine, Taiba Jabeen, Talaat Iman M, Tamuzi Jacques Lukenze, Tan Ker-Kan, Temsah Mohamad-Hani, Teramoto Masayuki, Thakur Ramna, Thankappan Kavumpurathu Raman, Thayakaran Rasiah, Thirunavukkarasu Sathish, Ticoalu Jansje Henny Vera, Tiwari Krishna, Tonelli Marcello, Topor-Madry Roman, Tovani-Palone Marcos Roberto, Tran An Thien, Tran Jasmine T, Tran Thang Huu, Tran Minh Duc Nguyen, Truelsen Thomas Clement, Truyen Thien Tan Tri Tai, Tsai Daniel Hsiang-Te, Ullah Atta, Unim Brigid, Unnikrishnan Bhaskaran, Unsworth Carolyn Anne, Usman Jibrin Sammani, Vahdati Sanaz, Vaithinathan Asokan Govindaraj, Valizadeh Rohollah, Van den Eynde Jef, Varghese 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机构信息
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
The National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
出版信息
JAMA Neurol. 2025 May 23. doi: 10.1001/jamaneurol.2025.1522.
IMPORTANCE
Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure.
OBJECTIVE
To estimate the worldwide burden of SAH.
DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021.
EXPOSURES
SAH and 14 modifiable risk factors.
MAIN OUTCOMES AND MEASURES
Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs).
RESULTS
In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution.
CONCLUSIONS AND RELEVANCE
Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.
重要性
非创伤性蛛网膜下腔出血（SAH）是第三大常见的中风类型，具有独特的病因、风险因素、诊断方法和治疗手段。然而，流行病学研究常常将SAH与其他中风类型归为一类，导致其独特的负担估计模糊不清。
目的
估计全球SAH负担。
设计、背景和参与者：基于重复横断面的《2021年全球疾病负担（GBD）研究》，估计了1990年至2021年全球SAH负担。此外，将SAH负担与其他疾病进行比较，并利用《2021年全球疾病负担研究》中的现有数据调查其与14种个体风险因素的关联。全球疾病负担研究包括1990年至2021年期间204个国家和地区所有年龄段非创伤性SAH的负担估计。
暴露因素
SAH和14种可改变的风险因素。
主要结局和测量指标
SAH发病率、患病率、死亡率和伤残调整生命年（DALY）的绝对数和年龄标准化率以及95%不确定区间（UI），以及特定风险因素的人群归因分数（PAF）。
结果
2021年，全球年龄标准化SAH发病率为8.3（95%UI，7.3 - 9.5），患病率为92.2（95%UI，84.1 - 100.6），死亡率为4.2（95%UI，3.7 - 4.8），DALY率为每10万人125.2（95%UI，110.5 - 142.6）。负担估计最高的地区是拉丁美洲、加勒比地区、大洋洲和高收入亚太地区。尽管SAH病例的绝对数量有所增加，特别是在社会人口指数较低的地区，但1990年至2021年期间所有年龄标准化负担率均有所下降：发病率下降28.8%（95%UI，25.7% - 31.6%），患病率下降16.1%（95%UI，14.8% - 17.7%），死亡率下降56.1%（95%UI，40.7% - 64.3%），DALY率下降54.6%（95%UI，42.8% - 61.9%）。在300种疾病中，SAH在全球范围内是第36大常见死因和第59大常见DALY原因。在全球所有与SAH相关的DALY中，71.6%（95%UI，63.8% - 78.6%）与14种建模风险因素相关，其中收缩压升高（人群归因分数[PAF] = 51.6%；95%UI，38.0% - 62.6%）和吸烟（PAF = 14.4%；95%UI，12.4% - 16.5%）的归因最高。
结论和意义
尽管在过去30年中全球年龄标准化SAH负担率下降了一半以上，但SAH仍然是全球最常见的心血管和神经死亡及残疾原因之一，且病例绝对数量不断增加。这些发现表明，积极的公共卫生规划和资源分配以预防SAH可能对健康有益。
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