Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Stroke Collaborators

doi:10.1016/S1474-4422(21)00252-0

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Stroke Collaborators

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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.

Original language	English
Pages (from-to)	795-820
Number of pages	26
Journal	The Lancet Neurology
Volume	20
Issue number	10
DOIs	https://doi.org/10.1016/S1474-4422(21)00252-0
Publication status	Published - Oct 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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10.1016/S1474-4422(21)00252-0Licence: CC BY

Publisher version (open access)Final published version, 5.45 MBLicence: CC BY

Cite this

@article{93df363bbf33404c97022bd83fb45b13,

title = "Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019",

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.",

author = "{GBD 2019 Stroke Collaborators} and Feigin, {Valery L.} and Stark, {Benjamin A.} and Johnson, {Catherine Owens} and Roth, {Gregory A.} and Catherine Bisignano and Abady, {Gdiom Gebreheat} and Mitra Abbasifard and Mohsen Abbasi-Kangevari and Foad Abd-Allah and Vida Abedi and Ahmed Abualhasan and Abu-Rmeileh, {Niveen M. E.} and Abushouk, {Abdelrahman I.} and Adebayo, {Oladimeji M.} and Gina Agarwal and Pradyumna Agasthi and Ahinkorah, {Bright Opoku} and Sohail Ahmad and Sepideh Ahmadi and Salih, {Yusra Ahmed} and Budi Aji and Samaneh Akbarpour and Akinyemi, {Rufus Olusola} and Hamad, {Hanadi Al} and Fares Alahdab and Alif, {Sheikh Mohammad} and Vahid Alipour and Aljunid, {Syed Mohamed} and Sami Almustanyir and Al-Raddadi, {Rajaa M.} and Salman, {Rustam Al-Shahi} and Nelson Alvis-Guzman and Robert Ancuceanu and Deanna Anderlini and Anderson, {Jason A.} and Adnan Ansar and Antonazzo, {Ippazio Cosimo} and Jalal Arabloo and Johan {\"A}rnl{\"o}v and Artanti, {Kurnia Dwi} and Zahra Aryan and Samaneh Asgari and Tahira Ashraf and Mohammad Athar and Alok Atreya and Marcel Ausloos and Baig, {Atif Amin} and Baltatu, {Ovidiu Constantin} and MacIej Banach and Barboza, {Miguel A.} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Barone, {Mark Thomaz Ugliara} and Sanjay Basu and Gholamreza Bazmandegan and Ettore Beghi and Mahya Beheshti and Yannick B{\'e}jot and Bell, {Arielle Wilder} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Bezabhe, {Woldesellassie Mequanint} and Bezabih, {Yihienew Mequanint} and Bhagavathula, {Akshaya Srikanth} and Pankaj Bhardwaj and Krittika Bhattacharyya and Ali Bijani and Boris Bikbov and Birhanu, {Mulugeta M.} and Archith Boloor and Aime Bonny and Michael Brauer and Hermann Brenner and Dana Bryazka and Butt, {Zahid A.} and Santos, {Florentino Luciano Caetano Dos} and Campos-Nonato, {Ismael R.} and Carlos Cantu-Brito and Carrero, {Juan J.} and Casta{\~n}eda-Orjuela, {Carlos A.} and Catapano, {Alberico L.} and Chakraborty, {Promit Ananyo} and Jaykaran Charan and Choudhari, {Sonali Gajanan} and Chowdhury, {Enayet Karim} and Dinh-Toi Chu and Sheng-Chia Chung and David Colozza and Costa, {Vera Marisa} and Simona Costanzo and Criqui, {Michael H.} and Omid Dadras and Baye Dagnew and Xiaochen Dai and Koustuv Dalal and Damasceno, {Albertino Antonio Moura} and Emanuele D'Amico and Lalit Dandona and Rakhi Dandona and Gela, {Jiregna Darega} and Kairat Davletov and Cruz-G{\'o}ngora, {Vanessa De La} and Rupak Desai and Deepak Dhamnetiya and Dharmaratne, {Samath Dhamminda} and Dhimal, {Mandira Lamichhane} and Meghnath Dhimal and Daniel Diaz and Martin Dichgans and Klara Dokova and Rajkumar Doshi and Abdel Douiri and Duncan, {Bruce B.} and Sahar Eftekharzadeh and Michael Ekholuenetale and Nahas, {Nevine El} and Elgendy, {Islam Y.} and Muhammed Elhadi and El-Jaafary, {Shaimaa I.} and Matthias Endres and Endries, {Aman Yesuf} and Erku, {Daniel Asfaw} and Faraon, {Emerito Jose A.} and Umar Farooque and Farshad Farzadfar and Feroze, {Abdullah Hamid} and Irina Filip and Florian Fischer and David Flood and Gad, {Mohamed M.} and Shilpa Gaidhane and Gheshlagh, {Reza Ghanei} and Ahmad Ghashghaee and Nermin Ghith and Ghozali Ghozali and Sherief Ghozy and Alessandro Gialluisi and Simona Giampaoli and Gilani, {Syed Amir} and Gill, {Paramjit Singh} and Gnedovskaya, {Elena V.} and Mahaveer Golechha and Goulart, {Alessandra C.} and Yuming Guo and Rajeev Gupta and Gupta, {Veer Bala} and Gupta, {Vivek Kumar} and Pradip Gyanwali and Nima Hafezi-Nejad and Samer Hamidi and Asif Hanif and Hankey, {Graeme J.} and Arief Hargono and Abdiwahab Hashi and Hassan, {Treska S.} and Hassen, {Hamid Yimam} and Havmoeller, {Rasmus J.} and Hay, {Simon I.} and Khezar Hayat and Hegazy, {Mohamed I.} and Claudiu Herteliu and Ramesh Holla and Sorin Hostiuc and Mowafa Househ and Junjie Huang and Ayesha Humayun and Bing-Fang Hwang and Licia Iacoviello and Ivo Iavicoli and Ibitoye, {Segun Emmanuel} and Ilesanmi, {Olayinka Stephen} and Ilic, {Irena M.} and Ilic, {Milena D.} and Usman Iqbal and Irvani, {Seyed Sina Naghibi} and Islam, {Sheikh Mohammed Shariful} and Ismail, {Nahlah Elkudssiah} and Hiroyasu Iso and Gaetano Isola and Masao Iwagami and Louis Jacob and Vardhmaan Jain and Sung-In Jang and Jayapal, {Sathish Kumar} and Shubha Jayaram and Ranil Jayawardena and Panniyammakal Jeemon and Jha, {Ravi Prakash} and Johnson, {Walter D.} and Jonas, {Jost B.} and Nitin Joseph and Jozwiak, {Jacek Jerzy} and Mikk J{\"u}risson and Rizwan Kalani and Rohollah Kalhor and Yogeshwar Kalkonde and Ashwin Kamath and Zahra Kamiab and Tanuj Kanchan and Himal Kandel and Andr{\'e} Karch and Katoto, {Patrick D. M. C.} and Kayode, {Gbenga A.} and Pedram Keshavarz and Khader, {Yousef Saleh} and Khan, {Ejaz Ahmad} and Khan, {Imteyaz A.} and Maseer Khan and Khan, {Moien A. B.} and Khatib, {Mahalaqua Nazli} and Jagdish Khubchandani and Kim, {Gyu Ri} and Kim, {Min Seo} and Kim, {Yun Jin} and Adnan Kisa and Sezer Kisa and Mika Kivim{\"a}ki and Dhaval Kolte and Ali Koolivand and Laxminarayana, {Sindhura Lakshmi Koulmane} and Ai Koyanagi and Kewal Krishan and Vijay Krishnamoorthy and Krishnamurthi, {Rita V.} and Kumar, {G. Anil} and Dian Kusuma and Vecchia, {Carlo La} and Ben Lacey and Lak, {Hassan Mehmood} and Tea Lallukka and Savita Lasrado and Lavados, {Pablo M.} and Matilde Leonardi and Bingyu Li and Shanshan Li and Hualiang Lin and Ro-Ting Lin and Xuefeng Liu and Lo, {Warren David} and Stefan Lorkowski and Giancarlo Lucchetti and Saute, {Ricardo Lutzky} and Razek, {Hassan Magdy Abd El} and Magnani, {Francesca Giulia} and Mahajan, {Preetam Bhalchandra} and Azeem Majeed and Alaa Makki and Reza Malekzadeh and Malik, {Ahmad Azam} and Navid Manafi and Mansournia, {Mohammad Ali} and Mantovani, {Lorenzo Giovanni} and Santi Martini and Giampiero Mazzaglia and Mehndiratta, {Man Mohan} and Menezes, {Ritesh G.} and Atte Meretoja and Mersha, {Amanual Getnet} and {Miao Jonasson}, Junmei and Bartosz Miazgowski and Tomasz Miazgowski and Michalek, {Irmina Maria} and Mirrakhimov, {Erkin M.} and Yousef Mohammad and Abdollah Mohammadian-Hafshejani and Shafiu Mohammed and Mokdad, {Ali H.} and Yaser Mokhayeri and Mariam Molokhia and Moni, {Mohammad Ali} and Montasir, {Ahmed Al} and Rahmatollah Moradzadeh and Lidia Morawska and Jakub Morze and Walter Muruet and Musa, {Kamarul Imran} and Nagarajan, {Ahamarshan Jayaraman} and Mohsen Naghavi and {Narasimha Swamy}, Sreenivas and Nascimento, {Bruno Ramos} and Negoi, {Ruxandra Irina} and {Neupane Kandel}, Sandhya and Nguyen, {Trang Huyen} and Bo Norrving and Noubiap, {Jean Jacques} and Nwatah, {Vincent Ebuka} and Bogdan Oancea and Odukoya, {Oluwakemi Ololade} and Olagunju, {Andrew T.} and Hans Orru and Owolabi, {Mayowa O.} and Padubidri, {Jagadish Rao} and Adrian Pana and Tarang Parekh and Eun-Cheol Park and {Pashazadeh Kan}, Fatemeh and Mona Pathak and Peres, {Mario F. P.} and Arokiasamy Perianayagam and Truong-Minh Pham and Piradov, {Michael A.} and Vivek Podder and Suzanne Polinder and Postma, {Maarten J.} and Akram Pourshams and Amir Radfar and Alireza Rafiei and Alberto Raggi and Fakher Rahim and Vafa Rahimi-Movaghar and Mosiur Rahman and Rahman, {Muhammad Aziz} and Rahmani, {Amir Masoud} and Nazanin Rajai and Priyanga Ranasinghe and Rao, {Chythra R.} and Rao, {Sowmya J.} and Priya Rathi and Rawaf, {David Laith} and Salman Rawaf and Reitsma, {Marissa B.} and Vishnu Renjith and Renzaho, {Andre M. N.} and Aziz Rezapour and Rodriguez, {Jefferson Antonio Buendia} and Leonardo Roever and Michele Romoli and Andrzej Rynkiewicz and Simona Sacco and Masoumeh Sadeghi and {Saeedi Moghaddam}, Sahar and Amirhossein Sahebkar and Saif-Ur-Rahman, {K. M.} and Rehab Salah and Mehrnoosh Samaei and Samy, {Abdallah M.} and Santos, {Itamar S.} and Santric-Milicevic, {Milena M.} and Nizal Sarrafzadegan and Brijesh Sathian and Davide Sattin and Silvia Schiavolin and Schlaich, {Markus P.} and Schmidt, {Maria Ines} and Schutte, {Aletta Elisabeth} and Sepanlou, {Sadaf G.} and Allen Seylani and Feng Sha and Saeed Shahabi and Shaikh, {Masood Ali} and Mohammed Shannawaz and Shawon, {Md Shajedur Rahman} and Aziz Sheikh and Sara Sheikhbahaei and Kenji Shibuya and Soraya Siabani and Silva, {Diego Augusto Santos} and Singh, {Jasvinder A.} and Singh, {Jitendra Kumar} and Skryabin, {Valentin Yurievich} and Skryabina, {Anna Aleksandrovna} and Sobaih, {Badr Hasan} and Stefan Stortecky and Saverio Stranges and Tadesse, {Eyayou Girma} and Tarigan, {Ingan Ukur} and Mohamad-Hani Temsah and Yvonne Teuschl and Thrift, {Amanda G.} and Marcello Tonelli and Tovani-Palone, {Marcos Roberto} and Tran, {Bach Xuan} and Manjari Tripathi and Tsegaye, {Gebiyaw Wudie} and Anayat Ullah and Brigid Unim and Bhaskaran Unnikrishnan and Alireza Vakilian and {Valadan Tahbaz}, Sahel and Vasankari, {Tommi Juhani} and Narayanaswamy Venketasubramanian and Dominique Vervoort and Bay Vo and Victor Volovici and Kia Vosoughi and Vu, {Giang Thu} and Vu, {Linh Gia} and Wafa, {Hatem A.} and Yasir Waheed and Yanzhong Wang and Tissa Wijeratne and Winkler, {Andrea Sylvia} and Wolfe, {Charles D. A.} and Mark Woodward and Wu, {Jason H.} and {Wulf Hanson}, Sarah and Xiaoyue Xu and Lalit Yadav",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2021",

month = oct,

doi = "10.1016/S1474-4422(21)00252-0",

language = "English",

volume = "20",

pages = "795--820",

journal = "The Lancet Neurology",

issn = "1474-4422",

publisher = "Lancet Publishing Group",

number = "10",

}

TY - JOUR

T1 - Global, regional, and national burden of stroke and its risk factors, 1990-2019

T2 - a systematic analysis for the Global Burden of Disease Study 2019

AU - GBD 2019 Stroke Collaborators

AU - Feigin, Valery L.

AU - Stark, Benjamin A.

AU - Johnson, Catherine Owens

AU - Roth, Gregory A.

AU - Bisignano, Catherine

AU - Abady, Gdiom Gebreheat

AU - Abbasifard, Mitra

AU - Abbasi-Kangevari, Mohsen

AU - Abd-Allah, Foad

AU - Abedi, Vida

AU - Abualhasan, Ahmed

AU - Abu-Rmeileh, Niveen M. E.

AU - Abushouk, Abdelrahman I.

AU - Adebayo, Oladimeji M.

AU - Agarwal, Gina

AU - Agasthi, Pradyumna

AU - Ahinkorah, Bright Opoku

AU - Ahmad, Sohail

AU - Ahmadi, Sepideh

AU - Salih, Yusra Ahmed

AU - Aji, Budi

AU - Akbarpour, Samaneh

AU - Akinyemi, Rufus Olusola

AU - Hamad, Hanadi Al

AU - Alahdab, Fares

AU - Alif, Sheikh Mohammad

AU - Alipour, Vahid

AU - Aljunid, Syed Mohamed

AU - Almustanyir, Sami

AU - Al-Raddadi, Rajaa M.

AU - Salman, Rustam Al-Shahi

AU - Alvis-Guzman, Nelson

AU - Ancuceanu, Robert

AU - Anderlini, Deanna

AU - Anderson, Jason A.

AU - Ansar, Adnan

AU - Antonazzo, Ippazio Cosimo

AU - Arabloo, Jalal

AU - Ärnlöv, Johan

AU - Artanti, Kurnia Dwi

AU - Aryan, Zahra

AU - Asgari, Samaneh

AU - Ashraf, Tahira

AU - Athar, Mohammad

AU - Atreya, Alok

AU - Ausloos, Marcel

AU - Baig, Atif Amin

AU - Baltatu, Ovidiu Constantin

AU - Banach, MacIej

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Barone, Mark Thomaz Ugliara

AU - Basu, Sanjay

AU - Bazmandegan, Gholamreza

AU - Beghi, Ettore

AU - Beheshti, Mahya

AU - Béjot, Yannick

AU - Bell, Arielle Wilder

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Bezabhe, Woldesellassie Mequanint

AU - Bezabih, Yihienew Mequanint

AU - Bhagavathula, Akshaya Srikanth

AU - Bhardwaj, Pankaj

AU - Bhattacharyya, Krittika

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Birhanu, Mulugeta M.

AU - Boloor, Archith

AU - Bonny, Aime

AU - Brauer, Michael

AU - Brenner, Hermann

AU - Bryazka, Dana

AU - Butt, Zahid A.

AU - Santos, Florentino Luciano Caetano Dos

AU - Campos-Nonato, Ismael R.

AU - Cantu-Brito, Carlos

AU - Carrero, Juan J.

AU - Castañeda-Orjuela, Carlos A.

AU - Catapano, Alberico L.

AU - Chakraborty, Promit Ananyo

AU - Charan, Jaykaran

AU - Choudhari, Sonali Gajanan

AU - Chowdhury, Enayet Karim

AU - Chu, Dinh-Toi

AU - Chung, Sheng-Chia

AU - Colozza, David

AU - Costa, Vera Marisa

AU - Costanzo, Simona

AU - Criqui, Michael H.

AU - Dadras, Omid

AU - Dagnew, Baye

AU - Dai, Xiaochen

AU - Dalal, Koustuv

AU - Damasceno, Albertino Antonio Moura

AU - D'Amico, Emanuele

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Gela, Jiregna Darega

AU - Davletov, Kairat

AU - Cruz-Góngora, Vanessa De La

AU - Desai, Rupak

AU - Dhamnetiya, Deepak

AU - Dharmaratne, Samath Dhamminda

AU - Dhimal, Mandira Lamichhane

AU - Dhimal, Meghnath

AU - Diaz, Daniel

AU - Dichgans, Martin

AU - Dokova, Klara

AU - Doshi, Rajkumar

AU - Douiri, Abdel

AU - Duncan, Bruce B.

AU - Eftekharzadeh, Sahar

AU - Ekholuenetale, Michael

AU - Nahas, Nevine El

AU - Elgendy, Islam Y.

AU - Elhadi, Muhammed

AU - El-Jaafary, Shaimaa I.

AU - Endres, Matthias

AU - Endries, Aman Yesuf

AU - Erku, Daniel Asfaw

AU - Faraon, Emerito Jose A.

AU - Farooque, Umar

AU - Farzadfar, Farshad

AU - Feroze, Abdullah Hamid

AU - Filip, Irina

AU - Fischer, Florian

AU - Flood, David

AU - Gad, Mohamed M.

AU - Gaidhane, Shilpa

AU - Gheshlagh, Reza Ghanei

AU - Ghashghaee, Ahmad

AU - Ghith, Nermin

AU - Ghozali, Ghozali

AU - Ghozy, Sherief

AU - Gialluisi, Alessandro

AU - Giampaoli, Simona

AU - Gilani, Syed Amir

AU - Gill, Paramjit Singh

AU - Gnedovskaya, Elena V.

AU - Golechha, Mahaveer

AU - Goulart, Alessandra C.

AU - Guo, Yuming

AU - Gupta, Rajeev

AU - Gupta, Veer Bala

AU - Gupta, Vivek Kumar

AU - Gyanwali, Pradip

AU - Hafezi-Nejad, Nima

AU - Hamidi, Samer

AU - Hanif, Asif

AU - Hankey, Graeme J.

AU - Hargono, Arief

AU - Hashi, Abdiwahab

AU - Hassan, Treska S.

AU - Hassen, Hamid Yimam

AU - Havmoeller, Rasmus J.

AU - Hay, Simon I.

AU - Hayat, Khezar

AU - Hegazy, Mohamed I.

AU - Herteliu, Claudiu

AU - Holla, Ramesh

AU - Hostiuc, Sorin

AU - Househ, Mowafa

AU - Huang, Junjie

AU - Humayun, Ayesha

AU - Hwang, Bing-Fang

AU - Iacoviello, Licia

AU - Iavicoli, Ivo

AU - Ibitoye, Segun Emmanuel

AU - Ilesanmi, Olayinka Stephen

AU - Ilic, Irena M.

AU - Ilic, Milena D.

AU - Iqbal, Usman

AU - Irvani, Seyed Sina Naghibi

AU - Islam, Sheikh Mohammed Shariful

AU - Ismail, Nahlah Elkudssiah

AU - Iso, Hiroyasu

AU - Isola, Gaetano

AU - Iwagami, Masao

AU - Jacob, Louis

AU - Jain, Vardhmaan

AU - Jang, Sung-In

AU - Jayapal, Sathish Kumar

AU - Jayaram, Shubha

AU - Jayawardena, Ranil

AU - Jeemon, Panniyammakal

AU - Jha, Ravi Prakash

AU - Johnson, Walter D.

AU - Jonas, Jost B.

AU - Joseph, Nitin

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N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2021/10

Y1 - 2021/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85118484263&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(21)00252-0

DO - 10.1016/S1474-4422(21)00252-0

M3 - Article

C2 - 34487721

SN - 1474-4422

VL - 20

SP - 795

EP - 820

JO - The Lancet Neurology

JF - The Lancet Neurology

IS - 10

ER -

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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