TY - JOUR
T1 - Global, regional, and national burden of stroke and its risk factors, 1990–2021
T2 - a systematic analysis for the Global Burden of Disease Study 2021
AU - GBD 2021 Stroke Risk Factor Collaborators
AU - Feigin, Valery L.
AU - Abate, Melsew Dagne
AU - Abate, Yohannes Habtegiorgis
AU - Abd ElHafeez, Samar
AU - Abd-Allah, Foad
AU - Abdelalim, Ahmed
AU - Abdelkader, Atef
AU - Abdelmasseh, Michael
AU - Abd-Elsalam, Sherief
AU - Abdi, Parsa
AU - Abdollahi, Arash
AU - Abdoun, Meriem
AU - Abd-Rabu, Rami
AU - Abdulah, Deldar Morad
AU - Abdullahi, Auwal
AU - Abebe, Mesfin
AU - Abeldaño Zuñiga, Roberto Ariel
AU - Abhilash, E. S.
AU - Abiodun, Olugbenga Olusola
AU - Abiodun, Olumide
AU - Abo Kasem, Rahim
AU - Aboagye, Richard Gyan
AU - Abouzid, Mohamed
AU - Abreu, Lucas Guimarães
AU - Abrha, Woldu Aberhe
AU - Abtahi, Dariush
AU - Abu Rumeileh, Samir
AU - Abualhasan, Ahmed
AU - Abualruz, Hasan
AU - Abu-Gharbieh, Eman
AU - Abukhadijah, Hana J.
AU - Abu-Rmeileh, Niveen ME
AU - Aburuz, Salahdein
AU - Babu, Abraham Samuel
AU - Bakkannavar, Shankar M.
AU - Boloor, Archith
AU - Dsouza, Haneil Larson
AU - Holla, Ramesh
AU - Jeganathan, Jayakumar
AU - Joseph, Nitin
AU - Koulmane Laxminarayana, Sindhura Lakshmi
AU - Kumar, Nithin
AU - Kumaran D, Senthil
AU - Mithra, Prasanna
AU - Nayak, Vinod C.
AU - Padubidri, Jagadish Rao
AU - Raghuveer, Pracheth
AU - Shetty, Adithi
AU - Unnikrishnan, Bhaskaran
AU - Yesodharan, Renjulal
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/10
Y1 - 2024/10
N2 - 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.
AB - 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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U2 - 10.1016/S1474-4422(24)00369-7
DO - 10.1016/S1474-4422(24)00369-7
M3 - Article
C2 - 39304265
AN - SCOPUS:85203982941
SN - 1474-4422
VL - 23
SP - 973
EP - 1003
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 10
ER -