**1.1 Intracerebral hemorrhage in the Araucanía region**

*Aging - Life Span and Life Expectancy*

shown in **Table 1**.

mRS 3–5, and 39% dead [11].

2009–2010 NHS, with 2.2 and 8.1%, respectively [10].

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

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

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

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

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

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

**Year Incidence Mortality DALYsa** 1990 58.26 (42.38–76·24) 43.21 (38.58–48.77) 884.19 (787.41–996.20) 2010 46.93 (35.24–61.38) 22.36 (19.41–26.57) 443.90 (385.72–519.42)

*Age-standardized incidence and mortality per 100,000 person-years and DALYs lost per 100,000 people, for* 

inactivity; 11.7% with alcoholism; and 33.3% who smoke [9].

oldest after the Valparaíso Region (13.6% 65+ years old) [19].

care unit to 34% of stroke cases in a public hospital in Santiago [15, 16].

**50**

*a*

**Table 1.**

*Disability-adjusted life-years.*

*hemorrhagic stroke, in Chile in 1990–2010.*

The Araucanía Region has an area of 31,842.3 km<sup>2</sup> , which represents 4.2% 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 inhabitants [19].

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 16 patients with ICH [25].

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 pressure compared to the other regions [10].

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