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Regional differences in the incidence of aneurysmal subarachnoid haemorrhage in Finland

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Abstract

Background

Over the years, the consensus has generally been that Finland is a country with a significantly high incidence of aneurysmal subarachnoid haemorrhage (SAH) when compared to the rest of the world, excluding Japan. Most of the traditionally cited Finnish incidence studies are several decades old and have clear differences in their methodology and study design. The objective of this study was to determine the hospital-admitted incidence of aneurysmal SAH at Tampere University Hospital between 1990 and 2014. We also compared the incidence to other geographical regions in Finland.

Methods

The material for this study consists of patients admitted to Tampere University Hospital between 1990 and 2014 with the presentation of aneurysmal SAH. There was a total of 1965 patients with aneurysmal SAH in our data.

Results

The mean hospital-admitted aneurysmal SAH incidence over the period was 7.41 per 100,000 person-years. The hospital-admitted aneurysmal SAH incidence in the Eastern Finland region was two-thirds greater than in the Tampere University Hospital region.

Conclusions

We observed a relatively steady hospital-admitted incidence of aneurysmal SAH (7.41 per 100,000 person-years) in the Tampere University Hospital region. This result is parallel to a recent study looking into the incidence of aneurysmal SAH for the whole of Finland. Compared to the Tampere University Hospital region, the incidence was 64% greater in the Eastern Finland region.

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Authors and Affiliations

  1. University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland

    Iiro Jalava, Liisa Pyysalo, Mikko Alanen, Oona Snicker, Juha Öhman & Antti Ronkainen

Authors
  1. Iiro Jalava
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  2. Liisa Pyysalo
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  3. Mikko Alanen
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  4. Oona Snicker
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  5. Juha Öhman
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  6. Antti Ronkainen
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Corresponding author

Correspondence to Iiro Jalava.

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No funding was received for this research.

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Comments

Jalava et al. present an interesting study on regional differences of the incidence of aneurysmal subarachnoid haemorrhage in Finland. The study design is simple but results seem to be robust (2).

The main advantage of the results obtained is the length of the studied period (15 years) and especially the organization of health care in Finland. It is reasonable to assume that not only catchment area is stable but also referral pattern is stable. In this aspect the presented study is unique. This study questions whether Finland is truly “the country of a thousands lakes and subarachnoid haemorrhage patients” or underlines the regional differences in the incidence of the aneurysmal haemorrhages.

It is to be discussed whether national level registries provide more precise and reliable data (3) or university based registries based on a rigid catchment area (2).

One should not forget that studies stating the high incidence of subarachnoid haemorrhages in Finland were performed in the 1970s and 1980s on a selected population sample of less than 400,000 inhabitants (2, 4).

It is to be answered by future studies whether regional impact on subarachnoid haemorrhage incidence is important or has ever been (within one country). One can argue in favour of regional differences or one can emphasize the lack of recent data on this topic. Studies on correlation of the cerebrovascular disease and regional differences are also somewhat older.

Jalava et al. should be acknowledged for their work showing the standard incidence of subarachnoid haemorrhage incidence in the Tampere catchment area. I would highly recommend a straightforward study on the incidence of subarachnoid haemorrhage in the whole of Finland. The study should be feasible due to the health system in Finland and could provide important data on this topic.

David Netuka

Prague, Czech Republic

References

1. Fogelholm R (1981) Subarachnoid haemorrhage in middle-Finland: incidence, early prognosis and indications for neurosurgical treatment. Stroke 12:296–301

2. Jalava I, Pyssalo L, Alanen M (2017) Regional differences in the incidence of aneurysmal subarachnoid haemorrhage in Finland. Acta Neurochir. doi:10.1007/s00701-017-3248-3

3. Korja M, Lehto H, Juvela S, Kaprio J (2016) Incidence of subarachnoid haemorrhage is decreasing together with decreasing smoking rates. Neurology 87:1118–23

4. Sarti C, Tuomilehto J, Salomaa V (1991) Epidemiology of subarachnoid haemorrhage in Finland from 1983 to 1985. Stroke 22: 848–853

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Jalava, I., Pyysalo, L., Alanen, M. et al. Regional differences in the incidence of aneurysmal subarachnoid haemorrhage in Finland. Acta Neurochir 159, 1657–1662 (2017). https://doi.org/10.1007/s00701-017-3248-3

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