Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
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Abstract
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. FUNDING: Bill & Melinda Gates Foundation.
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The record
- Venue
- The Lancet Neurology
- Topic
- Acute Ischemic Stroke Management
- Field
- Medicine
- Canadian institutions
- —
- Funders
- National Human Genome Research InstituteNational Research, Development and Innovation OfficeGuy's and St Thomas' NHS Foundation TrustFundação para a Ciência e a TecnologiaJapan Society for the Promotion of ScienceNational Health and Medical Research CouncilDaiichi Sankyo EuropeMedical Research CouncilNovo Nordisk PharmaNovartis PharmaNational Institutes of HealthLilly DeutschlandFogarty International CenterIdorsia PharmaceuticalsJenderal Soedirman UniversityItalfarmacoH. Lundbeck A/SCasen RecordatiSwedish Orphan BiovitrumAcademy of FinlandServierXiamen UniversityFondazione Umberto VeronesiUniversiti Kebangsaan MalaysiaTehran University of Medical Sciences and Health ServicesNational Institute of Neurological Disorders and StrokeUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversity of OxfordUnitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si InovariiKuwait UniversityAllerganNeuraxpharmNovo NordiskPrecursory Research for Embryonic Science and TechnologyKing Abdulaziz UniversityDSM Nutritional ProductsUltragenyx PharmaceuticalNational Research Foundation of KoreaConselho Nacional de Desenvolvimento Científico e TecnológicoMinistry of Science and ICT, South KoreaMinistero della SaluteGeneralitat de CatalunyaAOSpineAin Shams UniversityIntas PharmaceuticalsHögskolan DalarnaMonash UniversityDeutsche ForschungsgemeinschaftAfrican Academy of SciencesDepartment of Biotechnology, Ministry of Science and Technology, IndiaNational Heart Foundation of AustraliaNational Research FoundationCardiff UniversityNewcastle UniversityNovo Nordisk FondenDepartment of Health and Social CareBundesministerium für Bildung und ForschungEsperion TherapeuticsMinistry of Education, Culture, Sports, Science and TechnologyBritish Heart FoundationThe Wellcome Trust DBT India AllianceUniversity of QueenslandNational Institute for Health and Care ResearchWellcome TrustJohns Hopkins UniversityAmarin CorporationCardinal HealthAustralian Academy of ScienceAmryt PharmaAmerican Heart AssociationGovernment of CanadaKasturba Medical College, ManipalKarolinska InstitutetAgios PharmaceuticalsFresenius Medical Care North AmericaIstituto Auxologico ItalianoAustralian GovernmentAlzheimer's AssociationU.S. Department of DefenseBrigham and Women's HospitalGlobal Brain Health InstituteAutoritatea Natională pentru Cercetare StiintificăDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaInternational Hepato-Pancreato-Biliary AssociationBirzeit UniversityBill and Melinda Gates FoundationPfizerUniversità degli Studi di MilanoIran University of Medical SciencesHubei Provincial Department of EducationNational Authority for Scientific Research and InnovationKing Saud UniversityInternational Society of Travel MedicineSanofiEisaiNational Science and Technology CouncilKing's College Hospital NHS Foundation TrustCilagAmgenFondazione CariploRegeneron PharmaceuticalsUniversitas AirlanggaMcMaster UniversityKorean Diabetes AssociationHamad Medical CorporationUniversity of JordanHarvard UniversityInternational Atomic Energy AgencyUniversity of Technology SydneyAlexion PharmaceuticalsBristol-Myers SquibbAlfaisal UniversityTeva Pharmaceutical IndustriesAstraZenecaModernaBiogenKing's College LondonAmicus TherapeuticsAlexander von Humboldt-StiftungAstellas PharmaNational Institute for Health Research Applied Research Collaboration WestStudent Research Committee, Tabriz University of Medical SciencesBayerCanadian Institutes of Health ResearchEuropean CommissionLa Trobe UniversityCancer Research UKEli Lilly and CompanyDanoneAmerican Diabetes AssociationJapan Science and Technology AgencyEuropean Stroke OrganisationSociedad Madrileña de NefrologíaNational Cerebral and Cardiovascular Center
- Keywords
- Burden of diseaseStroke (engine)MedicineDiseaseDisease burdenEnvironmental healthInternal medicineEngineering
- Has abstract in OpenAlex
- yes