Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
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Résumé
BACKGROUND: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. METHODS: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]). INTERPRETATION: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. FUNDING: Bill & Melinda Gates Foundation.
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La notice
- Revue
- The Lancet Neurology
- Thématique
- Acute Ischemic Stroke Management
- Domaine
- Medicine
- Établissements canadiens
- —
- Organismes subventionnaires
- CilagPrecursory Research for Embryonic Science and TechnologyJapan Science and Technology AgencyNovartis PharmaAllerganNational Institutes of HealthEuropean Stroke OrganisationEsperion TherapeuticsNational Science and Technology CouncilDSM Nutritional ProductsIntas PharmaceuticalsLilly DeutschlandNational Research, Development and Innovation OfficeNational Health and Medical Research CouncilNeuraxpharmNovo Nordisk PharmaMinistry of Science and ICT, South KoreaMedical Research CouncilAfrican Academy of SciencesServierIstituto Auxologico ItalianoUniversity of JordanNovo NordiskEisaiConselho Nacional de Desenvolvimento Científico e TecnológicoMinistero della SaluteGeneralitat de CatalunyaMinistry of Education, Culture, Sports, Science and TechnologyAmryt PharmaAustralian Academy of ScienceJohns Hopkins UniversityAmarin CorporationCardinal HealthDaiichi Sankyo EuropeAgios PharmaceuticalsRegeneron PharmaceuticalsFondazione CariploFresenius Medical Care North AmericaDeutsche ForschungsgemeinschaftAlzheimer's AssociationGlobal Brain Health InstituteIdorsia PharmaceuticalsH. Lundbeck A/SInternational Hepato-Pancreato-Biliary AssociationGovernment of CanadaUltragenyx PharmaceuticalCanadian Institutes of Health ResearchItalfarmacoKorean Diabetes AssociationEuropean CommissionAstraZenecaInternational Atomic Energy AgencyAlexion PharmaceuticalsNational Research Foundation of KoreaBiogenKing Saud UniversityBristol-Myers SquibbTeva Pharmaceutical IndustriesAmerican Heart AssociationModernaBill and Melinda Gates FoundationPfizerAmicus TherapeuticsCasen RecordatiAlexander von Humboldt-StiftungJapan Society for the Promotion of ScienceSwedish Orphan BiovitrumAstellas PharmaBayerCardiff UniversityU.S. Department of DefenseEli Lilly and CompanyAOSpineDanoneAmerican Diabetes AssociationSociedad Madrileña de NefrologíaNational Research FoundationAmgenInternational Society of Travel MedicineNational Cerebral and Cardiovascular CenterSanofi
- Mots-clés
- Burden of diseaseStroke (engine)DiseaseMedicineEnvironmental healthInternal medicineEngineering
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