There has been a 25 percent increase in the number of strokes in people ages 20 to 64 years in the last 20 years, and "the global burden of stroke in terms of the absolute number of people affected every year, stroke survivors, related deaths, and disability-adjusted life-years (DALYs) lost are great and increasing, with most of the burden in low-income and middle-income countries," according to estimates from the Global Burden of Disease, Injuries, and Risk Factors Study 2010 (GBD 2010), published Oct. 23 in The Lancet.

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The authors used data from the GBD 2010 study to estimate the global and regional burden of stroke between 1990 and 2010, which included 119 studies from countries with various income levels. Results showed that "the age-standardized incidence of stroke significantly decreased by 12 percent (95 percent CI 6-17) in high-income countries, and increased by 12 percent in low-income and middle-income countries, albeit non-significantly."

Although stroke-related mortality has decreased significantly, in 2010, "the absolute numbers of people with first stroke (16.9 million), stroke survivors (33 million), stroke-related deaths (5.9 million), and DALYs lost (102 million) were high and had significantly increased since 1990 (68 percent, 84 percent, 26 percent, and 12 percent increase, respectively), with most of the burden (68.6 percent incident strokes, 52.2 percent prevalent strokes, 70.9 percent stroke deaths, and 77.7 percent DALYs lost) in low-income and middle-income countries."

In addition, the prevalence is increasingly growing in the young and middle-aged population, as "5.2 million (31 percent) strokes were in children (aged <20 years old) and young and middle-aged adults (20-64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74,000 (89 percent) and 4.0 million (78 percent), respectively." Further, the authors found significant geographical variations for the burden of stroke.

The authors add that "if the trends in stroke incidence, mortality, and DALYs continue, by 2013 there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally." According to Valery Feigin, MD, director of the National Institute for Stroke and Applied Neurosciences at Auckland University of Technology in New Zealand, and lead author of the study, "the worldwide stroke burden is growing very fast and there is now an urgent need for culturally acceptable and affordable stroke prevention, management and rehabilitation strategies to be developed and implemented worldwide."

A related editorial comment by Maurice Giroud, Agnes Jacquin and Yannick Bejot of the University of Burgundy, France, notes that "despite some improvements in stroke prevention and management in high-income countries, the growth and again of the global population is leading to a rise in the number of young and old patients with stroke." They add that moving forward, "urgent preventative measures and acute stroke care should be promoted in lower-income and middle-income countries, and the provision of chronic stroke care should be developed worldwide."

A separate study published in The Lancet also looked at the GBD 2010 study, and found that "in 2010, three fifths (61.5 percent) of the disability and more than half (51.7 percent) of the lives lost to stroke were the result of hemorrhagic strokes... despite being half as common as ischaemic strokes." Further the incidence of ischaemic and hemorrhagic stroke is mainly in low-income and middle-income countries, and in people younger than age 75.

Moving forward, in a related editorial comment, Graeme Hankey of the University of Western Australia, notes that "population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco by improving education and the environment will complement high-risk strategies of identifying those at risk of hemorrhagic (and ischaemic) stroke, thus empowering these individuals to improve their lifestyle behaviors, and if necessary, lower their mean blood pressure and blood pressure variability with appropriate doses of antihypertensive drugs."

Keywords: Stroke, Life Style, Income, Blood Pressure, Risk Factors, Child, Prevalence, Incidence, Intracranial Hemorrhages, Tobacco, Middle Aged, Quality-Adjusted Life Years

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