Global Burden of Stroke - Clinical Tree

Key Points

The Global Burden of Diseases (GBD) 2016 study shows that while mortality rates and mortality to incidence ratios for stroke have decreased, the global burden of stroke in terms of absolute numbers of incident strokes, survivors, stroke-related deaths, and disability adjusted life-years (DALYs) lost are high and have increased over the last three decades.
While there has been a decline in stroke incidence, mortality, mortality-to-incidence ratios, and DALYs in high-income countries, both the incidence and prevalence rates of stroke have increased in low and middle sociodemographic index (SDI) countries in the past two decades. Low and middle SDI countries have had a lower rate of reduction mortality rates and DALYs compared to high-income countries. Consequently, the burden of stroke is significantly higher in low SDI countries than in high and middle SDI countries.
While ischemic strokes comprise the highest number of strokes, most of the global burden of stroke in terms of DALY is due to hemorrhagic stroke. The incidence of hemorrhagic stroke increased significantly worldwide over the last two decades by 18.5%, while there was no significant change in the incidence of ischemic stroke. Low and middle SDI countries endure 80% of deaths due to hemorrhagic stroke.
The burden of stroke in people younger than 75 years has increased over the last two decades. Most of the ischemic stroke burden is in low and middle SDI countries, and both incident and fatal hemorrhagic and ischemic strokes occur at a younger age in these regions.
Worldwide, there has been a startling 25% increase in the incidence of stroke among adults aged 20–64 years over the last 20 years. This study showed, for the first time, that more than 83,000 children and youths aged 20 years and younger are affected by stroke in the world annually. Children and youths (aged <20 years) and young and middle-aged adults (20–64 years) constitute a startling 0.5% and 31% of all people with incident stroke, respectively.
Strategies to reduce burden at both population and individual levels to improve stroke awareness and implement targeted prevention strategies focused on risk factors (such as high blood pressure, high cholesterol, smoking, and unhealthy lifestyles) are essential to abate the currently alarming projections of stroke burden, particularly in low and middle SDI countries and in younger people.

Introduction

Stroke is the second leading cause of death worldwide after heart disease and was responsible for 6.1 million deaths and 130.6 million disability adjusted life-years (DALYs) in 2016. Stroke is preventable to a large extent as many of the risk factors for stroke are modifiable. Modifiable risk factors for stroke include high blood pressure, smoking, obesity, lack of physical activity, and unhealthy diets. The largest proportion of the burden of stroke has previously been reported to be in low-income countries ^, and the majority of stroke-related deaths occurred in low- and middle-income countries.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2016) is a systematic analysis and update of global data on the comparative magnitude of health loss due to disease, risk factors, and injuries from 1990 to 2016 by age, sex, and geographical region. ^, ^, Epidemiologic data from the past three decades from 195 countries was analyzed by the GBD 2016 investigators to provide the most recent and comprehensive estimates of the burden of 328 diseases and injuries and 264 causes of death including stroke. Statistical methods were developed to address incomplete epidemiologic data, particularly from low and middle sociodemographic index (SDI) countries. ^, ^, Stroke has a major health, economic, and societal burden particularly in the developing world; however, it is highly preventable. Therefore there is potential to dramatically reduce the impact of stroke by several means, including with adequate control of known risk factors. It is imperative to have a clear understanding of the global demographic pattern, distribution, and temporal trends of the burden of stroke to best inform health policies to reduce its burden.

Previous estimates from the GBD studies reveal a shift in overall global disease burden from communicable, maternal, neonatal, and nutritional causes towards noncommunicable diseases. This shift is likely to be a result of an increase in the world’s population, combined with an ageing population, and decreasing death rates by age, sex, and cause of death in the past three decades. Ischemic heart disease and stroke collectively resulted in 12.9 million (or one in four) deaths in 2017, compared with one in five deaths in 1990. Previous estimates by the World Health Organization (WHO) showed that ischemic heart disease and stroke combined were the leading causes of adult mortality in 2004. This chapter provides an overview of the most recent updates from the GBD 2016 stroke studies, with a brief description of the GBD methods and the most recent analysis of the global burden of stroke.

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