Advances in Stroke

Abstract

With ischemic heart disease (IHD) and stroke sharing many risk factors, one could presume a similar geographic pattern of stroke and IHD; however, Kim and Johnston described remarkable worldwide variations in disability-adjusted life-years (DALY) loss for both diseases.1 For stroke, much of Asia, eastern Europe, and Africa had DALY loss of ≥120/100 000 in contrast to North America, western Europe, and Australia having DALY loss rates ≤60/100 000. Eastern Europe and northern Asia also had strikingly high DALY loss (≥240/100 000) from IHD. Overall, there were 62 of 192 countries with higher DALY loss from stroke than for IHD, particularly for China, but also in many countries in Africa and South America. There were only marginally more countries (74 of 192) with higher DALY loss from IHD, particularly the Middle East, but also North America, Australia, and western Europe. Countries with lower national income, lower prevalence of diabetes, higher average alcohol intake, and less obesity tended to have higher DALY loss from stroke than IHD.1 The contributors to the substantial variations in stroke incidence within countries have been examined by reports including that by Grimaud and colleagues, who showed stroke incidence was as much as one third higher in regions of France with lower levels of socioeconomic status and/or higher levels of income inequality.2 A similar one third difference (32%) in stroke risk was observed between high socioeconomic status and low socioeconomic status neighborhoods in the United States.3 Attenuation of these neighborhood differences was larger with adjustment for biological risk factors (mediated to a 16% excess) than for behavioral risk factors (mediated to a 30% excess), suggesting that biological risk factors …