Burden, Temporal Trends, and Future Projections of Nontraumatic Intracerebral Hemorrhage in Asia, 1990–2050: A Systematic Analysis of the Global Burden of Disease Study 2021

INTRODUCTION: Nontraumatic intracerebral hemorrhage (ICH) is a major cause of mortality and disability in Asia, yet comprehensive assessments remain limited. We quantified the ICH burden across Asia during 1990-2021 and projected trends to 2050. METHODS: Using Global Burden of Disease study 2021 data, we analyzed age-standardized rates (ASRs) of prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (ASDR) by age, sex, and region. We examined correlations with the sociodemographic index (SDI) and Universal Health Coverage Index (UHCI) and forecast trends with Bayesian age-period-cohort modeling. RESULTS: From 1990 to 2021, absolute burden increased: prevalent cases 7.23→11.44 million, incident cases 1.59→2.56 million, deaths 1.64→2.56 million, and DALYs 44.20→60.54 million. ASRs declined: ASPR 295.05→221.51 per 100,000 (estimated annual percentage change -1.07), ASIR 82.35→52.35 (-1.79), ASMR 92.02→53.26 (-1.86), and ASDR 2,094.51→1,194.11 (-1.89). Males consistently had higher burdens; all ASRs increased with age. High systolic blood pressure was the leading risk factor. ASIR, ASMR, and ASDR were inversely correlated with SDI and UHCI (p < 0.001), whereas ASPR showed no association. Projections indicate continued declines in ASPR, ASIR, and ASMR through 2050. CONCLUSION: Despite broad declines in ASRs linked to healthcare advances, population aging is driving rising absolute burden. Region-specific preventive strategies are urgently needed to curb future ICH impact across diverse Asian settings.