Decreased aneurysmal subarachnoid hemorrhage incidence rate in elderly population than in middle aged population: a retrospective analysis of 8,144 cases in Mainland China

TL;DR

This retrospective study of 8,144 cases in China found that the incidence rate of aneurysmal subarachnoid hemorrhage decreases in elderly populations compared to middle-aged groups, challenging previous assumptions about aneurysm rupture risk.

Contribution

It provides new evidence that aneurysm rupture risk decreases after a certain age, suggesting aneurysm stability or rupture likelihood diminishes in the elderly.

Findings

Incidence rate decreases after age 65 in both sexes.

Males show a decrease after age 55.

Supports hypothesis that aneurysms stabilize or rupture early.

Abstract

Purpose: Rupture of an intracranial aneurysm is the most common cause of subarachnoid haemorrhage (SAH), which is a life-threatening acute cerebrovascular event that typically affects working-age people. This study aims to investigate the aneurysmal SAH incidence rate in elderly population than in middle aged population in China. Materials and methods: Aneurysmal SAH cases were collected retrospectively from the archives of 21 hospitals in Mainland China. All the cases collected were from September 2016 and backward consecutively for a period of time up to 8 years. SAH was initially diagnosed by brain computed tomography, and CT angiography (CTA) or digital subtraction angiography (DSA) was followed and SAH was confirmed to be due to cerebral aneurysm. When for cases multiple bleeding occurred, the age of the first SAH was used in this study. The toltal incidence from all hospital at each age were summed together for females and males; then adjusted by the total population number at each age for females and males. The total population data was from the 2010 population census of the People's Republic of China. Results: In total there were 8,144 cases, with 4,861 females and 3,283 males. Our analysis shows for both females and males the relative aneurysmal SAH rate started to decrease after around 65 years old. The males the relative aneurysmal SAH rate might have started to decrease after around 55 years old. Conclusion: In contrast to previous reports, our data demonstrated a decreased aneurysmal subarachnoid hemorrhage incidence rate in elderly population than in middle aged population. Our data therefore support the hypothesis that aneurysms do not grow progressively once they form but probably either rupture or stabilize and that very elderly patients are at a reduced risk of rupture compared with atients who are younger with the same-sized aneurysms.