AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Global and Regional Burden of High Alcohol Use Attributable Intracerebral Hemorrhage (1990-2023)
By Wasti SA, Wasti A, Qureshi AA et al.
Introduction: High alcohol consumption is a well-established modifiable risk factor for intracerebral hemorrhage (ICH). However, comprehensive evidence on long-term temporal trends and regional disparities in high alcohol use-attributable ICH burden remains limited. Research Questions: This study analyzes global, regional, and sociodemographic variations in age-standardized burden from 1990-2023. Methods: We analyzed Global Burden of Disease (GBD) 2023 estimates for age-standardized death rates (ASDRs) and disability-adjusted life years (DALYs) attributable to high alcohol use for ICH from 1990-2023. Temporal trends were assessed using Joinpoint regression to obtain average annual percent change (AAPC) with 95% confidence intervals (CI). Stratified analyses were conducted by Socio-demographic Index (SDI), World Bank (WB) regions, and income groups. Results: Globally, the age-standardized death rates (ASDR) showed a significant decline (AAPC -1.90%; 95% CI -2.42 to -1.39), falling from 1.81 to 0.94 per 100,000. Similar declining trends were observed across most Socio-demographic Index (SDI) groups, including high-SDI (AAPC -2.38%), high-middle SDI (-2.49%), and low-middle SDI (-0.57%). In contrast, low-SDI regions demonstrated a significant increase (AAPC +0.68%), while middle-SDI regions showed a modest but significant rise (AAPC +0.37%). By World Bank regions, consistent declines in ASDR were observed in East Asia & Pacific (-2.29%), Europe & Central Asia (-2.38%), Latin America & Caribbean (-2.72%), Middle East & North Africa (-2.52%), and high-income regions (-2.83%), whereas Sub-Saharan Africa showed a significant increase (+0.76%). At the income level, ASDR decreased significantly in high-income (-2.83%) and upper-middle-income countries (-2.51%), while lower-middle-income regions showed a significant increase (+0.89%). The DALY rates also declined significantly (AAPC -1.86%; 95% CI -2.40 to -1.33). Declines were consistent across high-SDI (-2.32%), high-middle SDI (-2.45%), and upper-middle-income settings (-2.49%). In contrast, low-SDI regions showed a significant increase in DALYs (AAPC +1.10%), with additional increases observed in Sub-Saharan Africa (+1.21%) and lower-middle-income countries (+1.24%). Most World Bank regions demonstrated significant reductions. Low-income regions showed a modest decline (-0.30%), while South Asia and North America showed a non-significant trend. Conclusions: The overall burden of high alcohol use-attributable ICH has fallen globally since 1990, especially in higher-income regions. In contrast, several lower-income settings are seeing rising or unchanged burden, highlighting persistent global disparities requiring targeted interventions.