Long-term survival after primary intracerebral hemorrhage: A population-based case-control study spanning a quarter of a century

Background and purpose The aim of this study was to determine the differences in life expectancy and causes of death after primary intracerebral hemorrhage (ICH) relative to general population controls. Methods In a population-based setting, 963 patients from Northern Ostrobothnia who had their first-ever ICH between 1993 and 2008 were compared with a cohort of 2884 sex and age-matched controls in terms of dates and causes of death (COD) as extracted from the Causes of Death Register kept by Statistics Finland and valid up to the end of 2017. Results Out of our 963 patients, 781 died during the follow-up time (mortality 81.1%). Cerebrovascular disease was the most common COD for these patients, 37.3%, as compared with 8.2% among the controls. The most common reasons for cerebrovascular mortality in the ICH patients were late sequelae of ICH in 12.8% (controls 0%) and new bleeding in 10.6% (controls 1.0%). The long-term survivors had a smaller ICH volume (median 12 ml) than those patients who died within three months (median 39 ml). The mortality rate of ICH patients during a follow-up between 12 and 24 years was still higher than that of their controls (hazard ratio 2.08, 95% confidence interval 1.58-2.74, p Conclusions Very long-term ICH survivors have a constant excess mortality relative to controls even 10 years after the index event. A significantly larger proportion of patients died of cerebrovascular causes and less because of cancer relative to the controls.