THE INFLUENCE OF INCREASED DETECTION AND TREATMENT OF UNRUPTURED INTRACRANIAL ANEURYSMS ON THE INCIDENCE OF SUBARACHNOID HEMORRHAGE; STUDY BASED ON THE NATIONAL HEALTH INSURANCE DATABASE

초록

Background and Aims: Although the diagnosis and treatment of unruptured intracranial aneurysms (UIA) are increasing, little is known about its effect on the incidence of subarachnoid hemorrhage (SAH). We performed this study to evaluate whether the increasing application of preventive treatment for UIA is associated with reducing the incidence of SAH or not. Methods: The incidence of UIA and SAH was estimated in serial crosssectional design using the database of the Korean National Health Insurance Service (KNHIS) and claim information from 2005 to 2015. Annual percent change (APC) and parallelism tests were estimated. We also evaluated whether any shift in treatment modality for UIA and SAH during study period. Results: The incidence of UIA increased from 6.1 per 100000 of the general population in 2005 to 28.3 in 2015. In contrast, the incidence of SAH decreased gradually over the study period (from 20.0/100 000 to 13.7/100 000) and the APC of SAH incidence was 3.93% (95% CI 4.2 to 3.7). In the UA group, the proportion of the treated patients by coiling or clipping increased to a peak of 38.4% in 2011 (35.1% in 2005) and then decreased to 34.8% in 2015. Whereas in the SAH group, percentages treated increased steadily. The proportion of patients treated by coiling increased with time (from 48% to 62% in UIA group, from 23% to 58,4% in SAH group). Conclusions: The marked increase in the detection and treatment of UIA might have contributed to the decreasing incidence of SAH, though the level of contribution could not be measured exactly. Trial registration number: N/A