Kidney Dysfunction-Associated Intracerebral Haemorrhage: Global Trends and Regional Disparities (1990-2021)

Kidney dysfunction is an increasingly recognized risk factor of intracerebral haemorrhage (ICH), but its global burden remains underexplored. This study systematically evaluated the burden, trends, health disparities, and future projections related to kidney dysfunction-associated ICH (KD-ICH) from 1990 to 2021.

Data were extracted from the Global Burden of Disease Study 2021. We estimated deaths, disability-adjusted life years (DALYs), and age-standardized mortality (ASMR) and DALY rates (ASDR) across sex, age, region, and sociodemographic index (SDI) strata. Temporal trends were analysed using the estimated annual percentage change. Health inequality was assessed using the Slope Index of Inequality (SII) and concentration index. Future projections to 2040 were generated using ARIMA models.

Between 1990 and 2021, the absolute burden of KD-ICH increased significantly, with deaths rising from 241,229 to 329,737 and DALYs increasing from 6.23 million to 8.05 million, despite a decline in global ASMR and ASDR. Older adults, especially those aged 60-79 years, and males were disproportionately affected. Nearly 75% of the global burden was concentrated in low-, middle-low-, and middle-SDI regions, which also experienced slower declines in ASR burden. The SDI and the KD-ICH burden were strongly negatively correlated, and healthy inequality metrics confirmed persistent and widening global disparities. The ARIMA model projected a continued decline in age-standardized burden through 2040.

The growing absolute burden and pronounced health inequities of KD-ICH highlight the need for context-specific prevention strategies, improved chronic disease management, greater health system investment, and equitable allocation of resources to address disparities and mitigate the future burden of KD-ICH.