Trends in mortality and disability-adjusted life years (DALYs) attributable to subarachnoid hemorrhage in South Asia (2000-2023).

This study aimed to analyze two-decade trends in mortality and disability-adjusted life years (DALYs) attributable to subarachnoid hemorrhage (SAH) across South Asian countries, highlighting regional and gender disparities and informing strategies for stroke prevention and care. Ecological trend analysis using publicly available population-level data from the Global Burden of Disease (GBD) database for the years 2000-2023.Population-level data for five South Asian countries: India, Pakistan, Bangladesh, Nepal, and Bhutan. Age-standardized mortality rates and DALYs per 100,000 population attributable to SAH. DALYs were further stratified into years of life lost (YLLs) and years lived with disability (YLDs). Gender-specific trends and country-level variations were assessed. Between 2000 and 2023, age-standardized rates for SAH showed significant variation in South Asian countries with increasing from 3.2 per 100,000 in 2000 to 4.2 per 100,000 in 2023, marking a 29.5% rise and an average annual percent change of 1.2% (95%CI:1.0-1.4). However, due to population growth and aging, absolute number of SAH related deaths increase from 26,951 to 65,635 deaths. India recorded the highest age-standardized mortality rate (36.1%) and absolute deaths (20,645 to 51,767), followed by Pakistan (25.3%). Bangladesh on the contrary showed a slight decline to 5.6 per 100,000 in 2023. DALY rates increased by 23.9% from 110.4 to 136.8 per 100,000, with an average annual percent change of 0.9% (95%CI:0.7-1.1). India and Pakistan experienced the most significant increases in absolute DALYs (India 851,404 to over 1.8 million and Pakistan 115,227 to 250,736). DALY rate in South Asia increased from 164.8 to 174.5 per 100,000) with average annual percent change of 0.3%. Our study showed both persistent growth and decreasing gender disparity in SAH related mortality and DALYs in South Asia. The age standardized mortality rate was 4.0 per 100,000 for females and 2.5 for males with an absolute difference of -1.5 and a relative difference of -37.2% in 2000. This remained high for females in 2023 at 4.6 and 3.7 for males showing a decrease in absolute difference of -0.8 and the relative difference to -18.0%. The risk factors that are contributing to SAH mortality in South Asia were hypertension, smoking, household air pollution due to solid fuel and body mass index. The burden of subarachnoid hemorrhage in South Asia has increased substantially, with rising age-standardized rates and a marked growth in absolute deaths and DALYs, particularly in India and Pakistan. Although gender disparities have narrowed over time, females continue to experience higher mortality rates than males. Targeted prevention addressing hypertension, smoking, household air pollution, and body mass index is urgently needed to reduce SAH burden in the region.