GBD 2021 Global Subarachnoid Hemorrhage Risk Factors CollaboratorsRautalin, IlariVolovici, VictorStark, Benjamin AJohnson, Catherine OKaprio, JaakkoKorja, MiikkaKrishnamurthi, Rita VNair, Balakrishnan SukumaranRanta, AnnemareiRinkel, Gabriel JEVergouwen, Mervyn DIAbate, Yohannes HabtegiorgisAbbastabar, HedayatAbd-Allah, FoadAbdelkader, AtefAbdi, ParsaAbdollahi, ArashAbdullahi, AuwalAbiodun, Olugbenga OlusolaAboagye, Richard GyanAbouzid, MohamedAbtahi, DariushAbu Rumeileh, SamirAbualhasan, AhmedAbualruz, HasanAbukhadijah, Hana JAbu-Zaid, AhmedAdamu, Lawan HassanAddo, Isaac YeboahAdedoyin, Rufus AdesojiAdegboye, Oyelola AAdra, SaryiaAdzigbli, Leticia AkuaAgyemang-Duah, WilliamsAhinkorah, Bright OpokuAhmad, AqeelAhmad, DanishAhmadzade, Amir MahmoudAhmed, AliAhmed, HaroonAhmed, Syed AneesAji, BudiAkkaif, Mohammed AhmedAl-Ajlouni, YazanAl-Aly, ZiyadAlbashtawy, MohammedAli, Mohammed UsmanAlif, Sheikh MohammadAlimohamadi, YousefAljunid, Syed MohamedAlomari, Mahmoud AAlrawashdeh, AhmadAlsabri, 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SiddharthanSenthilkumaran, SubramanianSepanlou, Sadaf GSethi, YashendraSeylani, AllenShaaban, Ahmed NabilShafie, MahanShahwan, Moyad JamalShaikh, Masood AliShaikh, Summaiya ZareenShamim, Muhammad AaqibShamsi, AnasShamsutdinova, AlfiyaShanawaz, MohdShannawaz, MohammedSharifan, AminSharifi Rad, JavadSharma, VishalShashamo, Bereket BeyeneShetty, MahabaleshShetty, Premalatha KShigematsu, MikaShittu, AminuShiue, IvyShlobin, Nathan AShorofi, Seyed AfshinSiddig, Emmanuel EdwarSingh, BaljinderSingh, ParamdeepSingh, PuneetpalSingh, SurjitSobia, FarrukhSolanki, RanjanSolanki, ShipraSoraneh, SoroushSpartalis, MichaelSrinivasamurthy, Suresh KumarStanaway, Jeffrey DStanikzai, Muhammad HaroonStarodubova, Antonina VSun, JingSun, ZhongSwain, Chandan KumarSzarpak, LukaszTabaee Damavandi, PayamTabatabaei, Seyyed MohammadTabatabaeizadeh, Seyed-AmirTabche, CelineTaiba, JabeenTalaat, Iman MTamuzi, Jacques LukenzeTan, Ker-KanTemsah, Mohamad-HaniTeramoto, MasayukiThakur, RamnaThankappan, Kavumpurathu RamanThayakaran, RasiahThirunavukkarasu, SathishTicoalu, Jansje Henny VeraTiwari, KrishnaTonelli, MarcelloTopor-Madry, RomanTovani-Palone, Marcos RobertoTran, An ThienTran, Jasmine TTran, Thang HuuTran Minh Duc, NguyenTruelsen, Thomas ClementTruyen, Thien Tan Tri TaiTsai, Daniel Hsiang-TeUllah, AttaUnim, BrigidUnnikrishnan, BhaskaranUnsworth, Carolyn AnneUsman, Jibrin SammaniVahdati, SanazVaithinathan, Asokan GovindarajValizadeh, RohollahVan den Eynde, JefVarghese, JoeVasankari, Tommi JuhaniVenketasubramanian, NarayanaswamyVervoort, DominiqueVillafañe, Jorge HugoVinayak, ManishVladimirov, Sergey KonstantinovitchWafa, Hatem AWaheed, YasirWahood, WaseemWalde, Mandaras TarikuWang, YanzhongWickramasinghe, Nuwan DarshanaWilleit, PeterWolde, Asrat ArjaWolfe, Charles DAWubie, Yihun MiskirXiao, HongXu, SuowenXu, XiaoyueYamagishi, KazumasaYano, YuichiroYarahmadi, AmirYaribeygi, HabibYaya, SanniYe, PengpengYon, Dong KeonYonemoto, NaohiroYu, ChuanhuaZanghì, AuroraZare, ImanZastrozhin, MichaelZhang, ChenZhang, YunquanZhang, Zhi-JiangZhang, ZhiqiangZhao, HanqingZhou, Shang ChengZhumagaliuly, AbzalZia, HafsaZielinska, MagdalenaZyoud, Samer HRoth, Gregory AFeigin, Valery L2025-06-102025-06-102025JAMA Neurology, ISSN: 2168-6149 (Print); 2168-6157 (Online), American Medical Association. doi: 10.1001/jamaneurol.2025.15222168-61492168-6157http://hdl.handle.net/10292/19290IMPORTANCE: Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. OBJECTIVE: To estimate the worldwide burden of SAH. DESIGN, SETTING, AND PARTICIPANTS: Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. EXPOSURES: SAH and 14 modifiable risk factors. MAIN OUTCOMES AND MEASURES: Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs). RESULTS: In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100 000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF] = 51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF = 14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. CONCLUSIONS AND RELEVANCE: Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.This is an open access article distributed under the terms of the CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium. You are not required to obtain permission to reuse this article content, provided that you credit the author and journal.Journal ArticleOpenAccess10.1001/jamaneurol.2025.1522