Abstract 3778: Trends in the Incidence, Types and Outcomes of Intracerebral Hemorrhage in Ontario from 1990 - 2010

Abstract

Background: Intracerebral hemorrhage (ICH) accounts for approximately 15% of all acute strokes and is associated with the highest stroke mortality. The purpose of this study was to examine the incidence of ICH in Ontario over the last 20 years and investigate whether there have been changes in patient characteristics and treatment interventions over time. Methods: We analyzed data from a provincial administrative database to determine the rates of ICH in Ontario from 1990 to 2010. Data from the Registry of the Canadian Stroke Network (RCSN) from 2003 to 2008 were then used to investigate potential changes in demographic variables (age, gender), stroke severity (Canadian Neurological Scale), comorbidities (hypertension, atrial fibrillation), preadmission medications (warfarin, antihypertensives), hemorrhage location (lobar vs. deep), initial glucose, initial INR and outcomes (modified Rankin Scale at discharge, hospital length of stay) in ICH patients over time. Results: There were 30,353 patients in the administrative database who were admitted with a final diagnosis of ICH between 1990 and 2010. The mean age of these patients was 70.3 years, 51.5% were male and the 30-day mortality rate was 40.6%. The age of patients with ICH increased over this time period (especially in the group >85 years of age), the length of hospital stay shortened and the 30-day mortality rate decreased slightly. Figure 1 shows the sex/age standardized ICH rate per 100,000 by fiscal year, which shows a decline in the ICH rate since 1997. From the 2,466 patients with ICH in the RCSN database from 2003 to 2008, the statistically significant changes included an increase in the lobar hemorrhage rate (39.2% to 46.9%, p=0.0000), an increase in the use of statins at admission (19% to 24%, p=0.0350) and a decrease in the mean systolic blood pressure (173.8±37.5 to 166.4±35.07, p=0.0040). There were no changes over time in neurosurgical interventions (craniotomy or intracranial pressure monitoring). Conclusions: In Ontario, based on hospitalizations, the rate of ICH increased until 1997 and since then has steadily decreased. This decline in the ICH rate over the past 12 years may reflect better management of hypertension.