ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Global burden of subarachnoid hemorrhage in young adults, 1990-2021: disparities, risk factors, and projections to 2050.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSubarachnoid hemorrhage (SAH) disproportionately affects young adults aged 15-49 years, yet prior global studies have rarely focused on this population and may obscure age-specific patterns by combining all-age data. We therefore quantified the global burden of SAH in young adults and explored disparities by sex and socio-demographic index (SDI) level.
methodsUsing Global Burden of Disease 2021 data from 204 countries (1990-2021), we estimated the age-standardized incidence rates (ASIR), age-standardized prevalence rates, age-standardized death rates, and age-standardized disability-adjusted life-year (DALY) rates. Temporal trends were assessed using estimated annual percentage changes and age-period-cohort models. We further evaluated cross-country disparities by SDI, examined risk attribution using population attributable fractions, projected future burden to 2050 using Bayesian age-period-cohort models, and conducted an exploratory machine learning analysis with SHapley Additive exPlanations.
resultsIn 2021, SAH caused 55,012 deaths and 3.19 million DALYs among young adults globally. Although the ASIR declined over time, the absolute burden remained substantial. High-SDI regions showed higher incidence, whereas lower-SDI regions bore a greater mortality and DALY burden. Males had a higher DALY burden, whereas females had higher prevalence. Metabolic risks were the leading contributors globally, while environmental and occupational risks remained more prominent in low-SDI settings. Projections suggested a continued decline in burden through 2050, although uncertainty widened after 2040.
conclusionSAH in young adults represents a non-uniform burden-transition pattern, with declining age-standardized rates but persistent premature mortality and DALYs, higher incidence in high-SDI settings, and greater fatal and disabling burden in lower-resource settings. These findings support stronger metabolic-risk reduction in high-SDI settings and improved blood pressure screening, referral, and acute-care access in lower-resource regions.
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