14 - Global Burden of Stroke

Abstract

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.