Abstract
BACKGROUND: Intracerebral hemorrhage (ICH), accounting for 10-15% of strokes, is linked to high mortality and severe disability, burdening patients, families, and society. Key modifiable risk factors include dietary habits and metabolic abnormalities. Dietary risks, such as excessive sodium intake, inadequate potassium consumption, and insufficient intake of fruits, vegetables, and whole grains, along with components of metabolic syndrome, including hypertension, dyslipidemia, and insulin resistance, are strongly associated with ICH. This study uses Global Burden of Disease data to assess ICH burden and its trends, guiding prevention strategies globally. METHODS: This study used data from the Global Burden of Disease (GBD) 2021 comparative risk assessment (CRA) framework to quantify the global burden of intracerebral hemorrhage (ICH) attributable to dietary and metabolic risk factors. The CRA approach defines specific risk-outcome pairs and estimates population-attributable fractions (PAFs) based on the difference between observed exposure levels and the theoretical minimum-risk exposure level (TMREL). Deaths and disability-adjusted life years (DALYs) were analyzed as main burden indicators, with variations assessed across sex, age group, region, and Sociodemographic Index (SDI). Temporal trends (1990-2021) were evaluated using the estimated annual percentage change (EAPC), and projections to 2050 were generated by the autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models. RESULTS: In 2021, there were 494,132 (95% UI: 176,420-910,628) deaths and 12,745,155 (95% UI: 4,643,556-22,891,812) disability-adjusted life years (DALYs) due to ICH linked to dietary risks, increasing from 1990 but accompanied by declining age-standardized mortality rate (ASMR: 5.73 [95% UI: 2.01-10.61]) and age-standardized DALY rate (ASDR: 145.88 [95% UI: 52.80-262.44]). For metabolic risks, deaths rose to 2,137,048 (95% UI: 1,723,175-2,528,845) and DALYs to 50,331,952 (95% UI: 40,288,092-59,299,298), while ASMR and ASDR decreased (25.13 [95% UI: 20.30-29.81] and 580.20 [95% UI: 464.54-683.84], respectively). Males exhibited higher ASMR and ASDR than females, and low-SDI regions carried the greatest burden. Forecasts suggest stable or slightly increasing deaths and DALYs but continuously declining standardized rates until 2050 (all estimates are presented with 95% uncertainty intervals [UIs] in accordance with the GBD 2021 conventions). CONCLUSION: Despite reductions in age-standardized ICH rates, the burden remains significant. Efforts should focus on mitigating modifiable risks in high-burden regions. Future research must evaluate interventions to guide global prevention strategies.