Abstract Body:

Introduction: Intracerebral Hemorrhage (ICH) is a significant type of stroke, being the second most common and with a higher risk of mortality and morbidity compared to ischemic stroke. The objective of this study is analyzing trends in the mortality rate of ICH in Brazil over a decade.
Methods: This was an ecological time-series analysis. Mortality data of ICH from January 2014 to June 2024 were extracted from the database system of Brazil's Ministry of Health (DATASUS) and analyzed for all age elderly groups, 60-69, 70-79, and 80 years and older. Joinpoint Trend Analysis Software version 5.2.0 was used to perform joinpoint regression and calculate the annual percent change (APC) and the average annual percent change (AAPC).
Results: A total of 41,213 deaths were reported during the analyzed period among individuals aged 60 years or older. Most patients were female (50.62%), white (37.83%), and within the 60 to 69 age group (39.16%). In the whole period, the mortality did not change significantly (AAPC -0.34 [CI -1.09 to 0.39], p > 0.05). However, mortality trends showed great fluctuations over time, with an increase from 2014 to 2020 (APC 1.61 [CI 0.63 to 3.70], p < 0.01), followed by a decrease from 2020 to 2024 (APC −3.19 [CI −6.65 to −1.45], p < 0.01). The 60–69 age cohort presented an estimated joinpoint in 2019 (2014–2019: APC 1.75 [CI 0.01 to 9.07], p < 0.05; 2019–2024: APC −1.97 [CI −8.07 to −0.30], p < 0.05). Meanwhile, the 70–79 age cohort's estimated joinpoint was in 2020 (2014–2020: APC 2.28 [CI 0.91 to 5.01], p < 0.01; 2020–2024: APC −4.15 [CI −8.29 to −1.74], p < 0.01). Finally, the age group over 80 years old had an estimated joinpoint in 2021 (2014–2021: APC 1.08 [CI 0.36 to 2.16], p < 0.01; 2021–2024: APC −4.73 [CI −8.13 to −2.38], p < 0.01), being the only group with an decrease in mortality when considering the whole period (AAPC -0.70 [CI -1.2691 to -0.1457], p < 0.05).
Conclusion:The fluctuation in mortality rates from ICH among the elderly may reflect broader trends in healthcare access and stroke risk management in Brazil. Moreover, the COVID-19 pandemic may have influenced these rates by contributing to premature deaths among the elderly before they could develop ICH and promoting improved medical care for patients with hypertension and other risk factors. Understanding these dynamics is important for maintaining the decline in mortality rates within this population through the development of targeted public health strategies.