Global and Regional Burden of Stroke During 1990-2010: Findings From the Global Burden of Disease Study 2010

Study Questions:

What are trends between 1990 and 2010 in global and regional stroke incidence, mortality, prevalence, and disability-adjusted life-years (DALYs) lost?

Methods:

This was a systematic review of 119 relevant studies published between 1990 and 2010. The authors used disease-specific, prespecified associations between incidence, prevalence, and mortality to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality, and DALYs lost. Results were stratified by age group (<75 years, ≥75 years, and in total) and country income level for 1990, 2005, and 2010.

Results:

While there was no overall change in the age-standardized incidence of stroke between 1990 and 2010, there was a 12% (95% confidence interval [CI], 6%-17%) statistically significant decrease in high-income countries and a 12% (95% CI, -3% to 22%) nonsignificant increase in low- and middle-income countries. There was a significant 25% reduction in mortality rate (37% [95% CI, 31%-41%] in high-income countries and 20% [95% CI, 15%-30%] in low- and middle-income countries). However, over the past two decades, there have been increases in the absolute number of individuals with incident stroke (a 68% increase), stroke survivors (84% increase), stroke-related deaths (26% increase), and DALYs lost (12%)—most of this burden was in low- and middle-income countries. In 2010, 5.2 million (31%) strokes were in children and young and middle-aged adults (20-64 years).

Conclusions:

Although there has been no overall change in age-standardized incidence of stroke over the past two decades and age-standardized rates of stroke mortality have decreased worldwide, there are trends toward increasing incident stroke, stroke-related death, and DALYs lost. Much of the burden is borne by low- and middle-income countries.

Perspective:

The limitations of this analysis aside (including the necessary and admittedly less rigorous case ascertainment for studies from low- and middle-income countries), the authors present a valuable report on the global burden of stroke. The authors project that ‘by 2030, there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally.’ Future studies should better characterize explanatory factors for disparities in some trends of stroke-related outcomes. The authors also draw attention to the proportion of young people and middle-aged adults affected by stroke, highlighting that stroke is not necessarily a disease of the elderly.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD and Pediatrics and Quality Improvement

Keywords: Survivors, Child, Prevalence, Stroke, Developed Countries, Middle Aged, Risk Factors, Cost of Illness, Quality-Adjusted Life Years


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