1 research outputs found
Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackgroundRegularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels.MethodsWe applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level.FindingsIn 2019, there were 12路2 million (95% UI 11路0-13路6) incident cases of stroke, 101 million (93路2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6路55 million (6路00-7路02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11路6% [10路8-12路2] of total deaths) and the third-leading cause of death and disability combined (5路7% [5路1-6路2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70路0% (67路0-73路0), prevalent strokes increased by 85路0% (83路0-88路0), deaths from stroke increased by 43路0% (31路0-55路0), and DALYs due to stroke increased by 32路0% (22路0-42路0). During the same period, age-standardised rates of stroke incidence decreased by 17路0% (15路0-18路0), mortality decreased by 36路0% (31路0-42路0), prevalence decreased by 6路0% (5路0-7路0), and DALYs decreased by 36路0% (31路0-42路0). However, among people younger than 70 years, prevalence rates increased by 22路0% (21路0-24路0) and incidence rates increased by 15路0% (12路0-18路0). In 2019, the age-standardised stroke-related mortality rate was 3路6 (3路5-3路8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3路7 (3路5-3路9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62路4% of all incident strokes in 2019 (7路63 million [6路57-8路96]), while intracerebral haemorrhage constituted 27路9% (3路41 million [2路97-3路91]) and subarachnoid haemorrhage constituted 9路7% (1路18 million [1路01-1路39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79路6 million [67路7-90路8] DALYs or 55路5% [48路2-62路0] of total stroke DALYs), high body-mass index (34路9 million [22路3-48路6] DALYs or 24路3% [15路7-33路2]), high fasting plasma glucose (28路9 million [19路8-41路5] DALYs or 20路2% [13路8-29路1]), ambient particulate matter pollution (28路7 million [23路4-33路4] DALYs or 20路1% [16路6-23路0]), and smoking (25路3 million [22路6-28路2] DALYs or 17路6% [16路4-19路0]).InterpretationThe annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.FundingBill & Melinda Gates Foundation
