Global, regional, and national burden of intracerebral hemorrhage, 1990–2021: an analysis of data from the global burden of disease study 2021

Intracerebral hemorrhage (ICH) represents one of the most lethal subtypes of stroke, with a disproportionately high burden of mortality and disability relative to its lower incidence compared to ischemic stroke. However, comprehensive evaluations of the global burden and projected trends of ICH based on GBD 2021 data remain limited. This study aims to analyze the burden of ICH at global, regional, and national levels, stratified by age, sex, and Sociodemographic Index (SDI). Data on the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of ICH and its related risk factors from 1990 to 2021 were extracted from the GBD 2021 project. To quantify temporal patterns and assess trends in age-standardized rates of ICH prevalence (ASPR), incidence (ASIR), mortality (ASDR), and disability-adjusted life years (DALYs), estimated annual percentage changes (EAPCs) were computed over the study period. Analyses were stratified by sex, 20 age groups, 21 GBD regions, 204 countries and territories, and five SDI quintiles. Globally, ICH accounted for an estimated 16.6 million prevalent cases, 3.44 million incident cases, 3.31 million deaths, and 79.5 million DALYs in 2021—each showing a substantial increase compared to 1990. Despite this rise in absolute numbers, the corresponding age-standardized rates, including ASPR, ASIR, ASDR, and age-standardized DALY rate, all declined over the same period. Regionally, a significant inverse correlation was found between the SDI and ICH burden. Burden increased with age, peaking at 70–74 years, and was consistently higher in males. Leading risk factors included hypertension, air pollution, smoking, and high sodium intake.