Spontaneous Intracranial Hemorrhage in Brazil: Trends, Seasonality, Pandemic Disruption, and Cost Burden
Thiago Oscar Goulart, Thire Baggio Machado Marazzi, Rosane Aparecida Monteiro, Millene Rodrigues Camilo, OCTÁVIO MARQUES PONTES-NETO
Abstract
BACKGROUND: Spontaneous intracranial hemorrhage (sICH) is a severe stroke subtype with high morbidity, mortality, and health care costs. This study evaluated national trends in sICH hospitalizations in Brazil from 2017 to 2022, focusing on seasonal variation, neurosurgical access, financial burden, and the impact of the COVID-19 pandemic. METHODS: We conducted a retrospective analysis using Departamento de Informática do Sistema Único de Saúde (Brazil's Public Health Database), Brazil's public health database, including all hospitalizations for International Classification of Diseases, 10th Revision codes I61 and I62 from January 2017 to December 2022. Time-series methods (Seasonal-Trend Decomposition using Loess decomposition, Chow test, Cumulative Sum, Augmented Dickey-Fuller, and Mann-Kendall) assessed temporal trends, seasonality, and structural changes. Outcomes included in-hospital mortality, neurosurgical procedures, length of stay, and hospitalization costs. RESULTS: A total of 114,030 sICH hospitalizations occurred (mean: 16,497/year). In-hospital mortality was 25%, totaling over 28,000 deaths. A significant structural break occurred in March 2020 (Chow test: P < 0.001), aligning with the pandemic onset. Admissions showed a sustained upward trend (Cumulative Sum: P = 0.002). Seasonal variation was evident, with peaks between May and September, confirmed by the Augmented Dickey-Fuller test (P < 0.001) and 12-month autocorrelation (ρ = 0.41). Neurosurgical access declined (11% to 8.8%). Decompressive craniectomy was performed in 3.6% of all admissions (21% of all surgeries). Conversely, neuroendoscopy was utilized 0.2% of cases. Mean length of stay decreased slightly from 10.2 to 9.4 days. Total hospitalization costs surged by 54%. CONCLUSIONS: The rising incidence, costs, and seasonal nature of sICH highlight a growing burden on the Brazilian public system. Current trends suggest demographic aging is outpacing prevention efforts, while the heavy reliance on decompressive techniques reveals a critical gap in the adoption of minimally invasive surgical options.