AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Three Decades of Tobacco-Attributable Subarachnoid Hemorrhage (1990-2023): Trends and Disparities
By Wasti SA, Wasti A, Qureshi AA et al.
Background: Tobacco exposure is a major modifiable risk factor for subarachnoid hemorrhage (SAH), yet the long-term global burden attributable to tobacco remains incompletely characterized across sociodemographic and geographic regions. Research Questions: To evaluate the global and regional burden of tobacco-attributable SAH. Methods: We analyzed age-standardized death rates (ASDRs) and DALY rates for tobacco-attributable SAH from the Global Burden of Disease 2023 estimates. Joinpoint regression was used to estimate annual percent change (APC) and average APC (AAPC) with 95% confidence intervals (CIs) globally and across Sociodemographic Index (SDI) strata, World Bank regions, and income groups between 1990-2023. Results: The global ASDR decreased from 1.89 per 100,000 in 1990 to 0.70 per 100,000 in 2023, with an overall AAPC of -2.93% (95% CI -3.12 to -2.74). DALY rates similarly declined from 58.78 to 24.25 per 100,000 (AAPC -2.66% (95% CI -2.92 to -2.41). The steepest reductions were observed in high-middle SDI regions (ASDR AAPC -4.54%; DALY AAPC -4.14%) and upper-middle-income countries (ASDR AAPC -4.30%; DALY AAPC -3.79%). The East Asia and Pacific region showed declines in both mortality (AAPC -4.22%) and DALYs (AAPC -3.61%). In contrast, low SDI regions showed worsening mortality trends overall (ASDR AAPC +0.35%; 95% CI 0.15 to 0.55), while DALY trends were non-significant (P=0.16). South Asia showed largely stable trends. Following 2020, several disadvantaged regions, including Sub-Saharan Africa, showed reversal patterns with rising ASDRs and DALY rates. Conclusions: Although tobacco-attributable SAH mortality and DALY burden has declined globally from 1990-2023, this improvement has not been seen in lower-income regions where progress has stagnated or reversed in recent years. Strengthening tobacco control policies and improving cerebrovascular prevention strategies in low- and middle-income countries is needed to reduce inequities in SAH burden worldwide.