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Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019


Feigin, VL and Stark, BA and Johnson, CO and Roth, GA and Bisignano, C and Abady, GG and Abbasifard, M and Abbasi-Kangevari, M and Abd-Allah, F and Abedi, V and Abualhasan, A and Abu-Rmeileh, NME and Abushouk, AI and Adebayo, OM and Agarwal, G and Agasthi, P and Ahinkorah, BO and Ahmad, S and Ahmadi, S and Salih, YA and Aji, B and Akbarpour, S and Akinyemi, RO and Al Hamad, H and Alahdab, F and Alif, SM and Alipour, V and Aljunid, SM and Almustanyir, S and Al-Raddadi, RM and Salman, RAS and Alvis-Guzman, N and Ancuceanu, R and Anderlini, D and Anderson, JA and Ansar, A and Antonazzo, IC and Arabloo, J and Arnlov, J and Artanti, KD and Aryan, Z and Asgari, S and Ashraf, T and Athar, M and Atreya, A and Ausloos, M and Baig, AA and Baltatu, OC and Banach, M and Barboza, MA and Barker-Collo, SL and Barnighausen, TW and Barone, MTU and Basu, S and Bazmandegan, G and Beghi, E and Beheshti, M and Bejot, Y and Bell, AW and Bennett, DA and Bensenor, IM and Bezabhe, WM and Bezabih, YM and Bhagavathula, AS and Bhardwaj, P and Bhattacharyya, K and Bijani, A and Bikbov, B and Birhanu, MM and Boloor, A and Bonny, A and Brauer, M and Brenner, H and Bryazka, D and Butt, ZA and Dos Santos, FLC and Campos-Nonato, IR and Cantu-Brito, C and Carrero, JJ and Castaneda-Orjuela, CA and Catapano, AL and Charan, J and Choudhari, SG and Chowdhury, EK and Chu, DT and Chung, SC and Colozza, D and Costa, VM and Costanzo, S and Criqui, MH and Dadras, O and Dagnew, B and Dai, X and Dalal, K and Damasceno, AAK and D'Amico, E and Dandona, L and Dandona, R and Gela, JD, Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019, The Lancet Neurology, 20, (10) pp. 795-820. ISSN 1474-4422 (2021) [Refereed Article]

DOI: doi:10.1016/S1474-4422(21)00252-0


Background: Regularly 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.

Methods: We 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.

Findings: In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) 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 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]).

Interpretation: The 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.

Item Details

Item Type:Refereed Article
Keywords:middle income countries; ischemic stroke; young adults; population; hypertension; prevention; guidelines; community
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Surgery
Objective Division:Health
Objective Group:Clinical health
Objective Field:Prevention of human diseases and conditions
UTAS Author:Bezabhe, WM (Dr Woldesellassie Bezabhe)
ID Code:152764
Year Published:2021
Web of Science® Times Cited:337
Deposited By:Pharmacy
Deposited On:2022-08-24
Last Modified:2022-11-15

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