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Incidence and long-term survival of spontaneous intracerebral hemorrhage over time: a systematic review and meta-analysis

Research output: Contribution to journalReview articlepeer-review

Original languageEnglish
Article number819737
Number of pages15
JournalFrontiers in Neurology
Early online date10 Mar 2022
Accepted/In press20 Jan 2022
E-pub ahead of print10 Mar 2022
Published10 Mar 2022

Bibliographical note

Funding Information: This study/project is funded by the National Institute for Health Research (NIHR) [Program Grants for Applied Research (NIHR202339)]. Funding Information: The authors acknowledge support from the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital (KCH) NHS Foundation Trust, and the NIHR Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, UK, and the Program of the China Scholarships Council (CSC 201808320212). Publisher Copyright: Copyright © 2022 Li, Zhang, Wolfe and Wang.


King's Authors


Background and Purpose: Recent epidemiological data indicate that the absolute number of hemorrhagic stroke cases increased by 47% between 1990 and 2010 and continued to cause high rates of death and disability. The last systematic review and meta-analysis of incidence and long-term survival of intracerebral hemorrhage (ICH) were published 11 and 7 years ago, respectively, and lacked comparison between different income groups, therefore, a more up to date analysis is needed. We aim to investigate the ICH incidence and long-term survival data in countries of different income groups. Materials Methods: We systematically searched Ovid Medline for population-based longitudinal studies of first-ever spontaneous ICH published from January 2000 to December 2020. We performed meta-analyses on the incidence and survival rate in countries of 4 different income groups with random-effects models (severe inconsistency). The I 2 was used to measure the heterogeneity. Heterogeneity was further investigated by conducting the meta-regression on the study mid-year. Time trends of the survival rate were assessed by weighted linear regression. Results: We identified 84 eligible papers, including 68 publications reporting incidence and 24 publications on the survival rate. The pooled incidence of ICH per 100,000 per person-years was 26.47 (95% CI: 21.84–32.07) worldwide, 25.9 (95% CI: 22.63–29.63) in high-income countries (HIC), 28.45 (95% CI: 15.90–50.88) in upper-middle-income countries, and 31.73 (95% CI: 18.41–54.7) in lower-middle-income countries. The 1-year pooled survival rate was from 50% (95% CI: 47–54%; n = 4,380) worldwide to 50% (95% CI: 47–54%) in HIC, and 46% (95% CI: 38–55%) in upper-middle income countries. The 5-year pooled survival rate was 41% (95% CI: 35–48%; n = 864) worldwide, 41% (95% CI: 32–50%) in high-income and upper-middle countries. No publications were found reporting the long-term survival in lower-middle-income and low-income countries. No time trends in incidence or survival were found by meta-regression. Conclusion: The pooled ICH incidence was highest in lower-middle-income countries. About half of ICH patients survived 1 year, and about two-fifths survived 5 years. Reliable population-based studies estimating the ICH incidence and long-term survival in low-income and low-middle-income countries are needed to help prevention of ICH. Systematic Review Registration:, PROSPERO CRD42020170140.

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