The Epidemiology of Intracerebral Haemorrahge. Risk factors and prognosis

Sammanfattning: Abstract The present thesis explored the epidemiology of intracerebral haemorrhage (ICH), i.e., factors associated to incidence and prognosis. In the population of Malmö (Malmö 1990 cohort), it was shown that immigrants from China/Vietnam and the Former Soviet Union had higher risk of ICH than citizens born in Sweden. Although hypertension is a well-known risk factor for stroke, the relation between blood pressure (BP) levels and stroke subtypes is less clear. In the Malmö Diet and Cancer cohort increasing BP was strongly associated with higher incidence of cerebral infarction, as measured by the crude and standardised incidence rates. However, in terms of relative risks (RR), the risk was highest for primary ICH (PICH), especially for nonlobar PICH. The results of previous studies have indicated differences in pathology and genetics between PICH subtypes by bleeding location. In the Malmö Preventive Project cohort, systolic BP and smoking were found to be associated with increased risk of lobar PICH. Systolic BP, psychiatric morbidity and diabetes were found to be associated with nonlobar PICH.. Of 474 patients with PICH (Malmö Stroke Registry), 26% died within 28 days and 49% within three years. Male sex predicted 28-day and 3-year mortality, largely explained by high 28-day mortality in male patients older than 75 years. It conclusion, the incidence of ICH varies by country of birth. The impact of high BP, in terms of RR, is highest for nonlobar PICH. Smoking is associated with lobar PICH, and diabetes with nonlobar PICH. Female PICH patients have better survival than men.