Our study aims to assess Intracerebral Hemorrhage-related mortality trends in the United States from 1999 to 2020.

Intracerebral Hemorrhage (ICH) constitutes 10-15% of all stroke cases associating it with significant disability and mortality. However, ICH-related mortality trends remain poorly understood.

We utilized death certificate data from the CDC-WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database to examine ICH-related mortality trends from 1999 to 2020. We calculated Age-Adjusted Mortality Rates (AAMRs) per 100,000 persons. Additionally, we calculated the Annual Percentage Change (APC) for each category using the Joinpoint Regression software.

Between 1999 and 2020, there were 546,248 ICH-related deaths. The AAMR decreased from 10.1 in 1999 to 6.6 in 2012 (APC: -3.48; 95% CI: -3.73 to -3.28). From 2012 onwards, the AAMR very slightly declined to 6.5 in 2020 (APC: -0.04; 95% CI: -0.59 to -0.69). Males had higher AAMRs than females from 1999 (AAMR males: 11.2 vs. females: 9.1) to 2020 (AAMR males: 7.5 vs. females: 5.6) and older adults (75 and above) had higher mortality rates than younger groups throughout the study period. Non-Hispanic African American adults had the highest AAMR (10.5), while Hispanic adults had the lowest (6.7). AAMRs also differed by census region (highest: South 8.0 and lowest: Northeast 6.8), and by urbanization level (AAMR: Non-metropolitan areas 8.1; Metropolitan areas 7.4). 

Following a decline from 1999 to 2012, ICH-related mortality in individuals in the US has almost plateaued. Males, African-Americans, older adults, non-metropolitan areas, and the southern U.S areas have the highest AAMRs, indicating targeted interventions in these populations.