Global burden and trends in intracerebral hemorrhage and subarachnoid hemorrhage attributable to metabolic risks in females over 50 years old from 1990 to 2021, with projections to 2050: a cross-sectional study

Background Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are major cerebrovascular events with significant global health burdens, particularly among females aged ≥ 50 years. Metabolic risk are critical factors in their pathogenesis. However, comprehensive global assessments of metabolic-related hemorrhage burdens in this population are limited. Methods Utilizing data from the Global Burden of Disease (GBD) Study 2021, we conducted a cross-sectional study to evaluate the burden of ICH and SAH attributable to metabolic risks in females aged ≥ 50 years from 1990 to 2021, with projections to 2050. Descriptive statistics, linear regression models, autoregressive integrated moving average (ARIMA) models, exponential smoothing (ES) models, and decomposition analysis were employed to analyze trends, projections, and contributing factors. Results In 2021, metabolic risks-related ICH in females aged ≥ 50 years resulted in 924,296 deaths [95% uncertainty interval (UI): 700,555-1,151,370] and 19,017,842 disability-adjusted life years (DALYs) (95% UI: 14,653,584 − 23,447,099). For SAH, the corresponding figures were 92,051 deaths (95% UI: 64,539 − 119,414) and 2,197,460 DALYs (95% UI: 1,567,672-2,793,233). From 1990 to 2021, while the absolute number of cases increased, the age-standardized rates (ASRs) decreased for both ICH and SAH. Projections to 2050 using ARIMA and ES models indicated upward trends in the number of cases, with ASRs remaining relatively stable or slightly decreasing. Decomposition analysis revealed that aging and population growth were the primary drivers of the increase in metabolic risks-related ICH and SAH burdens, partially offset by epidemiological transitions. Conclusion This study provides the first integrated assessment of the global burden of metabolic risks-related ICH and SAH in females aged ≥ 50 years. The findings highlight the substantial health burden and the need for targeted interventions to address metabolic risks, particularly in aging populations, to reduce preventable morbidity and mortality worldwide.