Background and Purpose:Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades.Methods:We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression.Results:Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27–2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P<0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15–2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04–1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09–4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56–2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93–1.09]).Conclusions:Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.

中文翻译：

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脑出血后的长期生存、死亡原因和 5 年死亡率趋势：特罗姆瑟研究

背景和目的：关于脑出血 (ICH) 后长期生存的数据很少。在一项基于人群的巢式病例对照研究中，我们比较了首次 ICH 的 30 天幸存者和对照组的长期生存率和 5 年内死亡原因，评估了心血管危险因素对 5 年死亡率的影响，并分析 ICH 患者 20 年 5 年死亡率的时间趋势。方法：我们纳入了来自基于人群的 Tromsø 研究的 219 名参与者，他们在基线参与后在 1994 年至 2013 年间首次发生 ICH，1095 岁和没有 ICH 的性别匹配的参与者。使用 Kaplan-Meier 方法呈现累积存活率。通过分层 Cox 比例风险模型估计 30 天幸存者死亡率和心血管危险因素与 5 年死亡率之间关联的风险比 (HR)。通过逻辑回归评估 5 年死亡率趋势。结果：与对照组相比，ICH 组的随访期间死亡风险（中位时间，4.8 年）增加（HR，1.62 [95% CI，1.27–2.06] ）。心血管疾病是死亡的主要原因，在 ICH 患者中的比例更高（22.9% 对 9.0%；磷<0.001)。吸烟增加了病例和对照组的 5 年死亡率（HR，1.59 [95% CI，1.15-2.19]），而血清胆固醇仅与病例的 5 年死亡率相关（HR，1.39 [95% CI， 1.04–1.86]）。ICH 发作时使用抗凝剂会增加死亡风险（HR，2.09 [95% CI，1.09–4.00]）。根据 ICH 位置没有差异（HR，1.15 [95% CI，0.56–2.37]）。在研究期间，五年死亡率没有变化（每个日历年的优势比，1.01 [95% CI，0.93-1.09]）。结论：病例的存活率显着低于对照组，这是由于增加了 2 倍心血管死亡的风险。吸烟、血清胆固醇和使用抗凝药物与 ICH 患者死亡风险增加有关。ICH 患者的 5 年死亡率随时间保持稳定。