What are the actual incidence and mortality rates of intracerebral hemorrhage?

From 1991 through 1996, we diagnosed 267 patients in Izumo City, Japan, as having primary intracerebral hemorrhage (ICH) by computed tomography or magnetic resonance imaging (proven ICH). The crude incidence rate was 52/100,000 per year for all ages; however, to estimate the actual incidence and mortality rates, we should take into account those who were presumed without confirmation to have died of ICH. From 1991 through 1996, we reviewed all 3,903 death certificates for the city of Izumo (population 84,854) and calculated the incidence and mortality rates of ICH by combining proven and possible ICH. We diagnosed 34 patients as having possible ICH on their death certificates and, when these were added to the 267 with proven ICH, the crude and the age- and sex-adjusted incidence rates for all ages became 59/100,000 per year and 53/100,000 per year, respectively. Of these, 19% (57) died by day 3 (day 0 being defined as the day of hemorrhage), and the overall survival rates at 1 month and 2 years were 77% and 65%, respectively. The crude and the age- and sex-adjusted 30-day mortality rates for all ages became 14/100,000 per year and 12/100,000 per year, respectively. When including those patients who may have died of ICH, the actual incidence rate of ICH is much higher than that reported to date, and the actual survival rate is still unsatisfactory.