**1. Introduction**

Stroke is the leading cause of disability and the second cause of death worldwide [1]. More than two thirds of the global burden of stroke occurs in developing countries, where the average age of patients is 15 years younger than in developed countries [2]. In the period 2000–2008, the total incidence rates in low- and middleincome countries exceeded the level of stroke incidence in high-income countries by 20% for the first time [3]. Latin America is experiencing an epidemiological transition toward older urban-dwelling adults that has led to a rise in cardiovascular risk factors and an increase in morbidity and mortality rates related to both stroke and myocardial infarction [4, 5]. According to the Global Burden of Disease 2013 Study (GBD 2013), stroke is the second cause of death in Latin America [6].

Stroke is also a serious public health problem in Chile. It is the leading cause of death in Chile, with a rate of 50.6 deaths per 100,000 inhabitants in 2011 [7]. Stroke accounted for 9% of all deaths in 2010 (8888 people) [8]. In addition, stroke is the first specific cause of disability-adjusted life years (DALY) in people older than 74 years and the fifth in those between 60 and 74 years [7]. 26,072 were hospitalized with the diagnosis of stroke in Chile in 2009 [8].

The prevalence of stroke in Chile, according to the National Health Survey (NHS) 2016–2017, is 2.6% in the general population and rises to 8.2% in ≥65 years [9]. A slight increase was observed when comparing the prevalence estimated in the 2009–2010 NHS, with 2.2 and 8.1%, respectively [10].

Intracerebral hemorrhage (ICH) is the second cause of stroke in Chile and represents approximately 23% of all strokes [11]. According to the Global Burden of Disease 2010 Study, the incidence of ICH in Chile is 46.9 per 100,000 person-years; the mortality is 22.36 per 100,000 person-years, and DALYs lost are 443.9 [12]. The comparison of the incidence, mortality, and DALYs between 1990 and 2010 is shown in **Table 1**.

The main source of information about the epidemiology of stroke comes from the Proyecto Investigación de Stroke en Chile: Iquique Stroke (PISCIS) Study conducted in Iquique in the north of Chile in 2000–2002 [11]. This study included 69 cases of first-ever ICH. Of these, 64 (92.7%) had spontaneous ICH. The mean age was 57.3 ± 17 years, and 62.3% of the subjects were male. The age-adjusted incidence rates were 13.8 (non-lobar) and 4.9 (lobar) per 100,000 person-years. Non-lobar ICH was more frequent in young men and lobar ICH in older women. The non-lobar-to-lobar ratio was similar to previous findings in Hispanics. Hypertension was more frequent in non-lobar ICH and in diabetes, while heavy drinking and antithrombotic use were more frequent in lobar ICH, but in none significantly. There was no association between location and prognosis [13]. In the PISCIS Study, the incidence rate per 100,000 was 27.6 for ICH. The case-fatality rate for incident ICH was 28.9 (17.7–44.8). The outcome at 6 months after the first-ever ICH was 33% of patients at mRankin 0–2, 28% at mRS 3–5, and 39% dead [11].

The INTERSTROKE (risk factors for ischemic and intracerebral hemorrhagic stroke in 22 countries) Study showed that hypertension, smoking, waist-tohip ratio, diet, and alcohol intake were significant risk factors for ICH [14]. According to the National Health Survey (NHS) 2016–2017, 27.6% of the population in Chile has hypertension; 73.3% in the subgroup ≥65 years old; 12.3% with diabetes (30.6% in ≥65); 74.2% with overweight-obesity; 86.7% with physical inactivity; 11.7% with alcoholism; and 33.3% who smoke [9].

In relation to the in-hospital management of ICH in Chile, the percentage of patients admitted with ICH varies from 14% in a private neurological intermediate care unit to 34% of stroke cases in a public hospital in Santiago [15, 16].

The most important risk factor for ICH is age. Each advancing decade from 50 years of age is associated with a twofold increase in ICH incidence [17]. In other words, ICH is more common in the elderly (1.97 x for each 10-year increase) [18]. This is a very important issue because according to the 2017 Chilean National Census, 11.4% of the population is 65+ years old [19]. On the other hand, in the Araucanía Region, 12.6% of population is 65+ years old; this region is the second oldest after the Valparaíso Region (13.6% 65+ years old) [19].


#### **Table 1.**

*Age-standardized incidence and mortality per 100,000 person-years and DALYs lost per 100,000 people, for hemorrhagic stroke, in Chile in 1990–2010.*

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ing daytime hours.

*Epidemiology and Management of Intracerebral Hemorrhage in Chile*

**1.1 Intracerebral hemorrhage in the Araucanía region**

The Araucanía Region has an area of 31,842.3 km<sup>2</sup>

of the American and insular territory [20]. The region has a 17.2% poverty by income, twice the national rate (8.6%) [21]. It also has 9.9 years average schooling (11.1% national) and 29.1% rurality that it is the second at the national level [19]. The Temuco-Padre Las Casas (PLC) conurbation has approximately 360,000

According to the 2017 Chilean National Census, 34.0% of those surveyed in the Araucanía Region stated they belonged to an indigenous or native group, a proportion significantly higher than the 12.8% registered nationally [19]. According to the National Socioeconomic Characterization Survey (CASEN) 2015, the indigenous population in Chile has worse socioeconomic indicators than nonindigenous [22]. For example, 18.3% of the indigenous population lives in poverty by income compared to 11% of the nonindigenous population; extreme poverty by income was 6.6 vs. 3.3%, respectively. Eighty-seven percent of the indigenous population is served in the public health system compared to 76.3% of the nonindigenous population [22]. There is evidence of a higher incidence of stroke among native populations and minorities [23, 24]. However, in a recent case-control study, we found no association between Mapuche ethnicity and stroke incidence. This study only included

The Araucanía Region, along with the Valparaíso, Maule, and Bío Bío regions, has double the mortality rate by stroke compared with the rest of the regions in Chile. Most of the increased risk is due to the prevalence of poverty, diabetes, sedentary lifestyle, and overweight [26]. Furthermore, according to the 2009–2010 NHS, the Araucanía Region has the highest prevalence of high systolic blood pres-

On the other hand, the incidence rate of stroke, calculated as a diagnosis of hospital discharge, in the period 2001–2010 in the Araucanía Sur Health Service,

ICH is the fourth most frequent reason for neurological consultation in the emergency room (ER) of the Hospital Dr. Hernán Henríquez Aravena (HHHA) in Temuco, Chile, accounting for 4.5–7% of the care provided by the neurologist and

The HHHA is located in the heart of the Temuco-PLC conurbation (360,000 inhabitants), about 670 kilometers south of Santiago de Chile. The HHHA has 730 beds, is the only hospital of high complexity in the Araucanía Region, and serves a beneficiary population of approximately 800,000 inhabitants [30]. The Araucanía Sur Health Service also has four medium-complexity hospitals (nodes) and eight low-complexity hospitals. The HHHA is also a referral center for neurological

The HHHA neurology unit does not have its own service and depends on the internal medicine service. Our hospital lacks a stroke unit [30]. The hospital has two CT scanners and a MRI. There is an interventional neuroradiologist (MP) dur-

The HHHA has face-to-face neurologists 24/7 in the ER since July 2013 [29]. Patients with mild ICH (ICH score 0–1) are admitted to the internal medicine service [31]. Patients with severe ICH (ICH score 2–3) are admitted to the ICU. The ICU has 54 beds (18 with mechanical ventilation) for a population of about 800,000

, which represents 4.2%

*DOI: http://dx.doi.org/10.5772/intechopen.86312*

inhabitants [19].

16 patients with ICH [25].

sure compared to the other regions [10].

13.5–18.1% of stroke cases [28, 29].

was 961.3 per 100,000 inhabitants/year [27].

**1.2 Management of intracerebral hemorrhage in the HHHA**

emergencies from the Araucanía Norte Health Service.
