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America's Aging Population Will Need More Neurosurgeons

By 2030, chronic subdural hemorrhage (SDH) – also know as subdural hematoma or brain bleeds — will be the most common adult brain condition requiring neurosurgical intervention in the U.S., according to a study conducted by researchers at NYU Langone Medical Center in New York City and published March 20th 2015 online in the Journal of Neurosurgery. Not only that, but hospitals and neurosurgeons may be under-manned to handle the projected onslaught of patients.

A release from the medical center explains that subdural hemorrhage is bleeding on the surface of the brain, usually caused by trauma to the head. It is more common in the elderly because of increased brain atrophy, greater use of anti-coagulant medications, and thinning of the delicate vessels stretching between the surface of the brain and its coverings. As a consequence, even minor head injuries can result in bleeding on the surface of the brain that can accumulate over time and lead to serious complications. The causative trauma can be so minor that, in fact, many people with SDHs have no history or recollection of a head or brain trauma incident.

SDHs are also more common in military veterans and in people with a history of alcohol abuse.

While clinicians know that certain populations have a greater likelihood of SDHs, precise incidence rates in the United States are unknown.

Research led by Uzma Samadani, MD, PhD, chief of neurosurgery at New York Harbor Health Care System and assistant professor in the Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology at NYU Langone, sought to quantify the future incidence rates for chronic SDH in U.S. Veterans Administration (VA) and civilian populations. They looked at current data from VA hospital visits where SDHs were diagnosed, as well as civilian incidence rates from Finland and Japan where accurate incidence records are available to create a mathematical model. This model, which accounted for age, gender and alcohol consumption, was designed to predict the incidence of SDH that would occur from 2012 to 2040 as the population ages.

Records from VA hospital visits from 2000 to 2012 showed that 695 new SDHs were identified, with 29% of these cases requiring a surgical drainage procedure. This translated to 79.4 SDHs per 100,000 veterans. In addition, more than 70% of SDHs occurred in patients 65 years of age and older. Based on this information, Dr. Samadani and her team determined that by 2030, when the U.S. population has aged to the extent that as many as 25% of people will be older than 65, the incidence of chronic SDH will reach approximately 121.4 cases per 100,000 people in the VA population and 17.6 cases per 100,000 people in the general U.S. population.