Location specific risk factors for intracerebral hemorrhage: Systematic review and meta-analysis

Objective To conduct a systematic review and meta-analysis of studies
reporting on risk factors according to the location of the intracerebral
hemorrhage. Methods We searched PubMed and Embase for cohort and
case-control studies reporting on ≥100 patients with spontaneous
intracerebral hemorrhage, that specified the location of the hematoma and
reported associations with risk factors published until June 27th 2019.
Two authors independently extracted data on risk factors. Estimates were
pooled with the generic variance-based random effects method. Results
After screening 10 013 articles, we included 42 studies totaling 26 174
patients with intracerebral hemorrhage (9 141 lobar and 17 033 non-lobar).
Risk factors for non-lobar intracerebral hemorrhage were hypertension
(risk ratio 4.25, 95% confidence interval 3.05-5.91, I2=92%), diabetes (RR
1.35, 1.11-1.64, I2=37% ), male sex (RR 1.63, 1.25-2.14, I2=61%), alcohol
overuse (RR 1.48, 1.21-1.81, I2=19%), underweight (RR 2.12, 1.12-4.01,
I2=31%), and being black (RR 2.19, 1.21-3.96, I2=96%) or Hispanic (RR
2.13,0.94-4.81, I2=71%) in comparison with being white. 
Hypertension, but not any of the other risk factors, was also a risk
factor for lobar intracerebral hemorrhage (RR 1.83, 1.39-2.42, I2=76%).
 Smoking, hypercholesterolemia and obesity were associated with
neither non-lobar nor lobar intracerebral hemorrhage. Conclusions
Hypertension is a risk factor for both non-lobar and lobar intracerebral
hemorrhage, although with double the effect for non-lobar intracerebral
hemorrhage. Diabetes, male sex, alcohol overuse, underweight, and being
black or Hispanic are risk factors for non-lobar intracerebral hemorrhage
only. Hence, the term “hypertensive intracerebral hemorrhage” for
non-lobar intracerebral hemorrhage is not appropriate.