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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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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
Authors: Feigin, VL
Stark, BA
Johnson, CO
Roth, GA
Bisignano, C
Abady, GG
Abbasifard, M
Abbasi-Kangevari, M
Abd-Allah, F
Abedi, V
Abualhasan, A
Jain, V
Jang, S-I
Jayapal, SK
Jayaram, S
Jayawardena, R
Jeemon, P
Jha, RP
Johnson, WD
Jonas, JB
Ahmed Salih, Y
Davletov, K
Joseph, N
Jozwiak, JJ
Jürisson, M
Kalani, R
Kalhor, R
Kalkonde, Y
Kamath, A
Kamiab, Z
Kanchan, T
Kandel, H
De la Cruz-Góngora, V
Aji, B
Karch, A
Katoto, PDMC
Kayode, GA
Keshavarz, P
Khader, YS
Khan, EA
Khan, IA
Khan, M
Khan, MAB
Desai, R
Khatib, MN
Akbarpour, S
Khubchandani, J
Kim, GR
Kim, MS
Kim, YJ
Kisa, A
Kisa, S
Kivimäki, M
Kolte, D
Dhamnetiya, D
Koolivand, A
Koulmane Laxminarayana, SL
Akinyemi, RO
Koyanagi, A
Krishan, K
Krishnamoorthy, V
Krishnamurthi, RV
Kumar, GA
Kusuma, D
La Vecchia, C
Dharmaratne, SD
Lacey, B
Lak, HM
Lallukka, T
Al Hamad, H
Lasrado, S
Lavados, PM
Leonardi, M
Li, B
Li, S
Lin, H
Dhimal, ML
Lin, R-T
Liu, X
Lo, WD
Lorkowski, S
Alahdab, F
Lucchetti, G
Lutzky Saute, R
Magdy Abd El Razek, H
Magnani, FG
Mahajan, PB
Dhimal, M
Majeed, A
Makki, A
Malekzadeh, R
Malik, AA
Manafi, N
Alif, SM
Mansournia, MA
Mantovani, LG
Martini, S
Mazzaglia, G
Diaz, D
Mehndiratta, MM
Menezes, RG
Meretoja, A
Mersha, AG
Miao Jonasson, J
Miazgowski, B
Alipour, V
Miazgowski, T
Michalek, IM
Mirrakhimov, EM
Dichgans, M
Mohammad, Y
Mohammadian-Hafshejani, A
Mohammed, S
Mokdad, AH
Mokhayeri, Y
Molokhia, M
Moni, MA
Aljunid, SM
Montasir, AA
Moradzadeh, R
Dokova, K
Morawska, L
Morze, J
Muruet, W
Musa, KI
Nagarajan, AJ
Naghavi, M
Narasimha Swamy, S
Nascimento, BR
Almustanyir, S
Negoi, RI
Abu-Rmeileh, NME
Neupane Kandel, S
Nguyen, TH
Norrving, B
Noubiap, JJ
Nwatah, VE
Oancea, B
Odukoya, OO
Olagunju, AT
Orru, H
Al-Raddadi, RM
Doshi, R
Owolabi, MO
Padubidri, JR
Pana, A
Parekh, T
Park, E-C
Pashazadeh Kan, F
Pathak, M
Peres, MFP
Perianayagam, A
Pham, T-M
Douiri, A
Al-Shahi Salman, R
Piradov, MA
Podder, V
Polinder, S
Postma, MJ
Pourshams, A
Radfar, A
Rafiei, A
Raggi, A
Rahim, F
Duncan, BB
Rahimi-Movaghar, V
Alvis-Guzman, N
Rahman, M
Rahman, MA
Rahmani, AM
Rajai, N
Ranasinghe, P
Rao, CR
Rao, SJ
Rathi, P
Eftekharzadeh, S
Rawaf, DL
Rawaf, S
Ancuceanu, R
Reitsma, MB
Renjith, V
Renzaho, AMN
Rezapour, A
Rodriguez, JAB
Roever, L
Romoli, M
Ekholuenetale, M
Rynkiewicz, A
Sacco, S
Sadeghi, M
Anderlini, D
Saeedi Moghaddam, S
Sahebkar, A
Saif-Ur-Rahman, KM
Salah, R
Samaei, M
Samy, AM
El Nahas, N
Santos, IS
Santric-Milicevic, MM
Sarrafzadegan, N
Sathian, B
Anderson, JA
Sattin, D
Schiavolin, S
Schlaich, MP
Schmidt, MI
Schutte, AE
Elgendy, IY
Sepanlou, SG
Seylani, A
Sha, F
Shahabi, S
Shaikh, MA
Ansar, A
Shannawaz, M
Shawon, MSR
Sheikh, A
Sheikhbahaei, S
Elhadi, M
Shibuya, K
Siabani, S
Silva, DAS
Singh, JA
Singh, JK
Skryabin, VY
Antonazzo, IC
Skryabina, AA
Sobaih, BH
Stortecky, S
El-Jaafary, SI
Stranges, S
Tadesse, EG
Tarigan, IU
Temsah, M-H
Teuschl, Y
Thrift, AG
Tonelli, M
Arabloo, J
Tovani-Palone, MR
Tran, BX
Endres, M
Tripathi, M
Tsegaye, GW
Ullah, A
Unim, B
Unnikrishnan, B
Vakilian, A
Valadan Tahbaz, S
Vasankari, TJ
Ärnlöv, J
Venketasubramanian, N
Abushouk, AI
Vervoort, D
Vo, B
Volovici, V
Vosoughi, K
Vu, GT
Vu, LG
Wafa, HA
Waheed, Y
Wang, Y
Artanti, KD
Endries, AY
Wijeratne, T
Winkler, AS
Wolfe, CDA
Woodward, M
Wu, JH
Wulf Hanson, S
Xu, X
Yadav, L
Yadollahpour, A
Yahyazadeh Jabbari, SH
Erku, DA
Aryan, Z
Yamagishi, K
Yatsuya, H
Yonemoto, N
Yu, C
Yunusa, I
Zaman, MS
Zaman, SB
Zamanian, M
Zand, R
Faraon, EJA
Zandifar, A
Asgari, S
Zastrozhin, MS
Zastrozhina, A
Zhang, Y
Zhang, Z-J
Zhong, C
Zuniga, YMH
Murray, CJL
Ashraf, T
Farooque, U
Athar, M
Atreya, A
Ausloos, M
Baig, AA
Baltatu, OC
Banach, M
Barboza, MA
Barker-Collo, SL
Bärnighausen, TW
Barone, MTU
Farzadfar, F
Basu, S
Bazmandegan, G
Beghi, E
Beheshti, M
Béjot, Y
Bell, AW
Bennett, DA
Bensenor, IM
Bezabhe, WM
Bezabih, YM
Feroze, AH
Bhagavathula, AS
Bhardwaj, P
Bhattacharyya, K
Bijani, A
Bikbov, B
Birhanu, MM
Boloor, A
Bonny, A
Brauer, M
Brenner, H
Filip, I
Bryazka, D
Butt, ZA
Caetano dos Santos, FL
Campos-Nonato, IR
Cantu-Brito, C
Carrero, JJ
Castañeda-Orjuela, CA
Catapano, AL
Chakraborty, PA
Charan, J
Fischer, F
Choudhari, SG
Chowdhury, EK
Chu, D-T
Chung, S-C
Colozza, D
Costa, VM
Costanzo, S
Criqui, MH
Dadras, O
Dagnew, B
Flood, D
Dai, X
Dalal, K
Damasceno, AAM
D'Amico, E
Dandona, L
Dandona, R
Darega Gela, J
Gad, MM
Adebayo, OM
Gaidhane, S
Ghanei Gheshlagh, R
Ghashghaee, A
Ghith, N
Ghozali, G
Ghozy, S
Gialluisi, A
Giampaoli, S
Gilani, SA
Gill, PS
Agarwal, G
Gnedovskaya, EV
Golechha, M
Goulart, AC
Guo, Y
Gupta, R
Gupta, VB
Gupta, VK
Gyanwali, P
Hafezi-Nejad, N
Hamidi, S
Agasthi, P
Hanif, A
Hankey, GJ
Hargono, A
Hashi, A
Hassan, TS
Hassen, HY
Havmoeller, RJ
Hay, SI
Hayat, K
Hegazy, MI
Ahinkorah, BO
Herteliu, C
Holla, R
Hostiuc, S
Househ, M
Huang, J
Humayun, A
Hwang, B-F
Iacoviello, L
Iavicoli, I
Ibitoye, SE
Ahmad, S
Ilesanmi, OS
Ilic, IM
Ilic, MD
Iqbal, U
Irvani, SSN
Islam, SMS
Ismail, NE
Iso, H
Isola, G
Iwagami, M
Ahmadi, S
Jacob, L
Item Type: Journal Article
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. Funding Bill & Melinda Gates Foundation.
Issue Date: Oct-2021
Date of Acceptance: 1-Sep-2021
URI: http://hdl.handle.net/10044/1/91526
DOI: 10.1016/s1474-4422(21)00252-0
ISSN: 1474-4422
Publisher: Elsevier BV
Start Page: 795
End Page: 820
Journal / Book Title: The Lancet Neurology
Volume: 20
Issue: 10
Copyright Statement: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
MIDDLE-INCOME COUNTRIES
ISCHEMIC-STROKE
YOUNG-ADULTS
POPULATION
HYPERTENSION
PREVENTION
PREVALENCE
GUIDELINES
MORTALITY
SERVICES
Adult
Aged
Aged, 80 and over
Body Mass Index
Cerebral Hemorrhage
Female
Global Burden of Disease
Humans
Incidence
Income
Ischemic Stroke
Male
Middle Aged
Prevalence
Quality-Adjusted Life Years
Risk Factors
Stroke
Subarachnoid Hemorrhage
GBD 2019 Stroke Collaborators
Humans
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Body Mass Index
Incidence
Prevalence
Risk Factors
Quality-Adjusted Life Years
Adult
Aged
Aged, 80 and over
Middle Aged
Income
Female
Male
Stroke
Global Burden of Disease
Ischemic Stroke
Neurology & Neurosurgery
1103 Clinical Sciences
1109 Neurosciences
Publication Status: Published
Open Access location: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00252-0/fulltext#
Online Publication Date: 2021-09-03
Appears in Collections:Imperial College Business School
Faculty of Medicine
School of Public Health



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