Temporal Trends in Hypertensive Subarachnoid Hemorrhage Mortality in the United States, 1999-2023: A Population-based Joinpoint Regression Analysis
Ammad Abid1, Arham Khalid Farooq1, Annas Mehzam2, Muhammad Usman Iqbal1, Muhammad Nabeel Saddique1, Muhammad Moiz Javed3, Asim Abdullah1
1King Edward Medical University, 2Central Park Medical College, 3Geisinger College of Health Sciences
Objective:
To analyze temporal trends in SAH-related mortality among hypertensive patients in the U.S. from 1999–2023 using Joinpoint regression.
Background:
Subarachnoid hemorrhage (SAH) secondary to hypertension remains a major cerebrovascular cause of death. Despite advances in hypertension control and neurosurgical care, mortality patterns across demographic subgroups remain underexplored.
Design/Methods:
Mortality data were obtained from the CDC WONDER database using ICD-10 codes I60 (subarachnoid hemorrhage) and I10–I15 (hypertensive diseases). Age-adjusted mortality rates (AAMR) per 100,000 population were analyzed by sex, race, census region, and urbanization level, and crude rates (CR) by age group. Trends were assessed using Joinpoint regression to estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals (CIs).
Results:
From 1999–2023, 40,198 deaths were attributed to hypertensive SAH. Overall AAMR (0.725) increased significantly (AAPC = 0.97%, p = 0.031). Females had higher AAMR (0.80) than males (0.62), but mortality rose only among males (AAPC = 1.91%, p < 0.001). Asian/Pacific Islanders had the highest AAMR (1.27) yet showed a decline (AAPC = −1.33%, p < 0.001); rates were stable among Black individuals, while White populations showed an increase (AAPC = 1.37%, p < 0.001). Regional variation was evident (West 0.90, South 0.72, Midwest 0.65, Northeast 0.63), with rising mortality in the South (AAPC = 1.64%, p = 0.001) and West (AAPC = 1.07%, p = 0.018). Rural areas showed increasing mortality (AAPC = 2.02%, p = 0.012) despite slightly lower AAMR (0.66) than urban areas (0.71). The steepest increases occurred among ages 75–84 (AAPC = 6.52%, p = 0.004) and 85+ (AAPC = 5.43%, p < 0.001). Columbia showed persistently high but stable rates, whereas Nevada exhibited the sharpest recent rise.
Conclusions:
Mortality from hypertensive SAH is rising, especially among males, elderly adults, Whites, and rural populations, highlighting disparities in hypertension control and cerebrovascular care.
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