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Burden of aneurysmal subarachnoid haemorrhage deaths in middle-aged people is relatively high
  1. Ilari Rautalin1,
  2. Jaakko Kaprio2,
  3. Miikka Korja1
  1. 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2Institute for Molecular Medicine FIMM, University of Helsinki Institute of Life Sciences, Helsinki, Finland
  1. Correspondence to Ilari Rautalin, Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki FI-00029, Finland; ilari.rautalin{at}

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The number of deaths resulting from aneurysmal subarachnoid haemorrhage (aSAH) is commonly considered negligible in comparison with other causes of death. In fact, it has been estimated that subarachnoid haemorrhage accounts for only 4% of stroke deaths.1 However, addressing the aSAH death toll is challenging since many aSAH deaths happen outside of hospitals and are commonly classified as cardiac deaths when autopsies are not done.2 3

Middle-aged people are affected most frequently by aSAH. Since cancer-, traffic-, alcohol- and cardiovascular-related deaths are decreasing in middle-aged people in high-income countries,4 we hypothesise that the proportion of aSAH deaths may be increasing in this age group. Therefore, we aimed to determine the proportion of aSAH deaths relative to other causes of death in middle-aged people.


Ethical considerations

Statistics Finland and the National Institute of Health and Welfare approved the data extractions and analysis from the nationwide Cause of Death (CDR) and Hospital Discharge Registers (HDR). According to Finnish legislation, no separate informed consent was required, as we did not access personally identifiable information.

Study period

Since 1936, all deaths in Finland have been archived to the nationwide CDR governed by Statistics Finland. The causes of death have been classified using the 10th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding from 1996 onwards. To avoid possible misclassification immediately after the transition to ICD-10, we included death diagnoses between 1998 and 2017.

Causes of death

We extracted aSAH deaths registered to the CDR with the four-character ICD-10 classification codes (I60.0–I60.6). We used the nationwide HDR …

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  • Contributors All authors contributed to the study conception and design. Material preparation and data analyses were performed by IR, but all authors contributed to data interpretation. The first draft of the manuscript was written by IR and all authors commented on previous versions of the manuscript. Language revision was performed by Jacquelin De Faveri. All authors and contributors read and approved the final manuscript.

  • Funding IR received personal research grants from Maire Taponen, Paulo and Aarne Koskelo foundations (no specific grant numbers available).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.