Trend and Prediction Analysis of the Changing Disease Burden of Intracranial Hemorrhage in China and Worldwide from 1990 to 2021 postprint

Abstract: Background  Intracranial hemorrhage（ICH）is a leading cause of death and disability globally，and analyzing its disease burden is crucial for developing effective prevention strategies. Objective  To analyze the evolution of the ICH disease burden and its risk factors in China and globally from 1990 to 2021，and to predict the disease burden trend from 2022 to 2035，providing a scientific basis for precise prevention and control measures. Methods  Based on the Global Burden of Disease（GBD）2021 database，we analyzed ICH incidence，mortality，and disability-adjusted life years（DALY）in China and globally. Joinpoint regression was used to calculate the average annual percentage change（AAPC）in disease burden trends，and a Bayesian age-period-cohort（BAPC）model was applied to predict ICH incidence，mortality，and DALY burden from 2022 to 2035. The comparative risk assessment framework of GBD was used to evaluate the attributable effects of risk factors such as high systolic blood pressure，smoking，and air pollution on the disease burden. Results  In 2021，the number of ICH cases globally and in China was 3 444 338 and 1 173 288，respectively，representing increases of 46.1% and 51.6% compared to 1990. From 1990 to 2021，the global age-standardized incidence rate showed a downward trend（AAPC=-0.589%，P<0.001），with a more significant decline in China（AAPC=-1.507%，P<0.001）. In 2021，the number of ICH deaths globally and in China was 3 308 367 and 1 322 893，respectively，representing increases of 41.3% and 44.9% compared to 1990. The global age-standardized mortality rate decreased（AAPC=-0.731%，P<0.001），with a more substantial decrease in China（AAPC=-2.265%，P<0.001）. China's age-standardized DALY rate for ICH in 2021 showed a significant decline compared to 1990（AAPC=-47.371%，P<0.001），while the global age-standardized DALY rate also decreased（AAPC=-19.309%，P<0.001）. High systolic blood pressure，smoking，and environmental particulate pollution were the main risk factors. The disease burden was higher in males than in females across all age groups，with the highest burden in those aged 65 and older. Predictive analysis indicates a declining trend in the global ICH disease burden from 2022 to 2035. Conclusion  China has made positive progress in controlling the ICH disease burden but still needs to focus on prevention and control measures for males，the elderly，and major risk factors. In the future，strengthening public health policies，improving medical resource efficiency，and promoting healthy lifestyles could further reduce the ICH disease burden and enhance patients' quality of life.