Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Feigin, Valery L; Stark, Benjamin A; Johnson, Catherine Owens; Roth, Gregory A; Bisignano, Catherine; Abady, Gdiom Gebreheat; Abbasifard, Mitra; Abbasi-Kangevari, Mohsen; Abd-Allah, Foad; Abedi, Vida; Abualhasan, Ahmed; Abu-Rmeileh, Niveen ME; Abushouk, Abdelrahman I; Adebayo, Oladimeji M; Agarwal, Gina; Agasthi, Pradyumna; Ahinkorah, Bright Opoku; Ahmad, Sohail; Ahmadi, Sepideh; Ahmed Salih, Yusra; Aji, Budi; Akbarpour, Samaneh; Akinyemi, Rufus Olusola; Al Hamad, Hanadi; Alahdab, Fares; Alif, Sheikh Mohammad; Alipour, Vahid; Aljunid, Syed Mohamed; Almustanyir, Sami; Al-Raddadi, Rajaa M; Al-Shahi Salman, Rustam; Alvis-Guzman, Nelson; Ancuceanu, Robert; Anderlini, Deanna; Anderson, Jason A; Ansar, Adnan; Antonazzo, Ippazio Cosimo; Arabloo, Jalal; Ärnlöv, Johan; Artanti, Kurnia Dwi; Aryan, Zahra; Asgari, Samaneh; Ashraf, Tahira; Athar, Mohammad; Atreya, Alok; Ausloos, Marcel; Baig, Atif Amin; Baltatu, Ovidiu Constantin; Banach, Maciej; Barboza, Miguel A; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Barone, Mark Thomaz Ugliara; Basu, Sanjay; Bazmandegan, Gholamreza; Beghi, Ettore; Beheshti, Mahya; Béjot, Yannick; Bell, Arielle Wilder; Bennett, Derrick A; Bensenor, Isabela M; Bezabhe, Woldesellassie Mequanint; Bezabih, Yihienew Mequanint; Bhagavathula, Akshaya Srikanth; Bhardwaj, Pankaj; Bhattacharyya, Krittika; Bijani, Ali; Bikbov, Boris; Birhanu, Mulugeta M; Boloor, Archith; Bonny, Aime; Brauer, Michael; Brenner, Hermann; Bryazka, Dana; Butt, Zahid A; Caetano dos Santos, Florentino Luciano; Campos-Nonato, Ismael R; Cantu-Brito, Carlos; Carrero, Juan J; Castañeda-Orjuela, Carlos A; Catapano, Alberico L; Chakraborty, Promit Ananyo; Charan, Jaykaran; Choudhari, Sonali Gajanan; Chowdhury, Enayet Karim; Chu, Dinh-Toi; Chung, Sheng-Chia; Colozza, David; Costa, Vera Marisa; Costanzo, Simona; Criqui, Michael H; Dadras, Omid; Dagnew, Baye; Dai, Xiaochen; Dalal, Koustuv; Damasceno, Albertino Antonio Moura; D'Amico, Emanuele; Dandona, Lalit; Dandona, Rakhi; Darega Gela, Jiregna; Davletov, Kairat; De la Cruz-Góngora, Vanessa; Desai, Rupak; Dhamnetiya, Deepak; Dharmaratne, Samath Dhamminda; Dhimal, Mandira Lamichhane; Dhimal, Meghnath; Diaz, Daniel; Dichgans, Martin; Dokova, Klara; Doshi, Rajkumar; Douiri, Abdel; Duncan, Bruce B; Eftekharzadeh, Sahar; Ekholuenetale, Michael; El Nahas, Nevine; Elgendy, Islam Y; Elhadi, Muhammed; El-Jaafary, Shaimaa I; Endres, Matthias; Endries, Aman Yesuf; Erku, Daniel Asfaw; Faraon, Emerito Jose A; Farooque, Umar; Farzadfar, Farshad; Feroze, Abdullah Hamid; Filip, Irina; Fischer, Florian; Flood, David; Gad, Mohamed M; Gaidhane, Shilpa; Ghanei Gheshlagh, Reza; Ghashghaee, Ahmad; Ghith, Nermin; Ghozali, Ghozali; Ghozy, Sherief; Gialluisi, Alessandro; Giampaoli, Simona; Gilani, Syed Amir; Gill, Paramjit Singh; Gnedovskaya, Elena V; Golechha, Mahaveer; Goulart, Alessandra C; Guo, Yuming; Gupta, Rajeev; Gupta, Veer Bala; Gupta, Vivek Kumar; Gyanwali, Pradip; Hafezi-Nejad, Nima; Hamidi, Samer; Hanif, Asif; Hankey, Graeme J; Hargono, Arief; Hashi, Abdiwahab; Hassan, Treska S; Hassen, Hamid Yimam; Havmoeller, Rasmus J; Hay, Simon I; Hayat, Khezar; Hegazy, Mohamed I; Herteliu, Claudiu; Holla, Ramesh; Hostiuc, Sorin; Househ, Mowafa; Huang, Junjie; Humayun, Ayesha; Hwang, Bing-Fang; Iacoviello, Licia; Iavicoli, Ivo; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Irena M; Ilic, Milena D; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ismail, Nahlah Elkudssiah; Iso, Hiroyasu; Isola, Gaetano; Iwagami, Masao; Jacob, Louis; Jain, Vardhmaan; Jang, Sung-In; Jayapal, Sathish Kumar; Jayaram, Shubha; Jayawardena, Ranil; Jeemon, Panniyammakal; Jha, Ravi Prakash; Johnson, Walter D; Jonas, Jost B; Joseph, Nitin; Jozwiak, Jacek Jerzy; Jürisson, Mikk; Kalani, Rizwan; Kalhor, Rohollah; Kalkonde, Yogeshwar; Kamath, Ashwin; Kamiab, Zahra; Kanchan, Tanuj; Kandel, Himal; Karch, André; Katoto, Patrick DMC; Kayode, Gbenga A; Keshavarz, Pedram; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Khan, Imteyaz A; Khan, Maseer; Khan, Moien AB; Khatib, Mahalaqua Nazli; Khubchandani, Jagdish; Kim, Gyu Ri; Kim, Min Seo; Kim, Yun Jin; Kisa, Adnan; Kisa, Sezer; Kivimäki, Mika; Kolte, Dhaval; Koolivand, Ali; Koulmane Laxminarayana, Sindhura Lakshmi; Koyanagi, Ai; Krishan, Kewal; Krishnamoorthy, Vijay; Krishnamurthi, Rita V; Kumar, G Anil; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lak, Hassan Mehmood; Lallukka, Tea; Lasrado, Savita; Lavados, Pablo M; Leonardi, Matilde; Li, Bingyu; Li, Shanshan; Lin, Hualiang; Lin, Ro-Ting; Liu, Xuefeng; Lo, Warren David; Lorkowski, Stefan; Lucchetti, Giancarlo; Lutzky Saute, Ricardo; Magdy Abd El Razek, Hassan; Magnani, Francesca Giulia; Mahajan, Preetam Bhalchandra; Majeed, Azeem; Makki, Alaa; Malekzadeh, Reza; Malik, Ahmad Azam; Manafi, Navid; Mansournia, Mohammad Ali; Mantovani, Lorenzo Giovanni; Martini, Santi; Mazzaglia, Giampiero; Mehndiratta, Man Mohan; Menezes, Ritesh G; Meretoja, Atte; Mersha, Amanual Getnet; Miao Jonasson, Junmei; Miazgowski, Bartosz; Miazgowski, Tomasz; Michalek, Irmina Maria; Mirrakhimov, Erkin M; Mohammad, Yousef; Mohammadian-Hafshejani, Abdollah; Mohammed, Shafiu; Mokdad, Ali H; Mokhayeri, Yaser; Molokhia, Mariam; Moni, Mohammad Ali; Montasir, Ahmed Al; Moradzadeh, Rahmatollah; Morawska, Lidia; Morze, Jakub; Muruet, Walter; Musa, Kamarul Imran; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Narasimha Swamy, Sreenivas; Nascimento, Bruno Ramos; Negoi, Ruxandra Irina; Neupane Kandel, Sandhya; Nguyen, Trang Huyen; Norrving, Bo; Noubiap, Jean Jacques; Nwatah, Vincent Ebuka; Oancea, Bogdan; Odukoya, Oluwakemi Ololade; Olagunju, Andrew T; Orru, Hans; Owolabi, Mayowa O; Padubidri, Jagadish Rao; Pana, Adrian; Parekh, Tarang; Park, Eun-Cheol; Pashazadeh Kan, Fatemeh; Pathak, Mona; Peres, Mario F P; Perianayagam, Arokiasamy; Pham, Truong-Minh; Piradov, Michael A; Podder, Vivek; Polinder, Suzanne; Postma, Maarten J; Pourshams, Akram; Radfar, Amir; Rafiei, Alireza; Raggi, Alberto; Rahim, Fakher; Rahimi-Movaghar, Vafa; Rahman, Mosiur; Rahman, Muhammad Aziz; Rahmani, Amir Masoud; Rajai, Nazanin; Ranasinghe, Priyanga; Rao, Chythra R; Rao, Sowmya J; Rathi, Priya; Rawaf, David Laith; Rawaf, Salman; Reitsma, Marissa B; Renjith, Vishnu; Renzaho, Andre M N; Rezapour, Aziz; Rodriguez, Jefferson Antonio Buendia; Roever, Leonardo; Romoli, Michele; Rynkiewicz, Andrzej; Sacco, Simona; Sadeghi, Masoumeh; Saeedi Moghaddam, Sahar; Sahebkar, Amirhossein; Saif-Ur-Rahman, KM; Salah, Rehab; Samaei, Mehrnoosh; Samy, Abdallah M; Santos, Itamar S; Santric-Milicevic, Milena M; Sarrafzadegan, Nizal; Sathian, Brijesh; Sattin, Davide; Schiavolin, Silvia; Schlaich, Markus P; Schmidt, Maria Inês; Schutte, Aletta Elisabeth; Sepanlou, Sadaf G; Seylani, Allen; Sha, Feng; Shahabi, Saeed; Shaikh, Masood Ali; Shannawaz, Mohammed; Shawon, Md Shajedur Rahman; Sheikh, Aziz; Sheikhbahaei, Sara; Shibuya, Kenji; Siabani, Soraya; Silva, Diego Augusto Santos; Singh, Jasvinder A; Singh, Jitendra Kumar; Skryabin, Valentin Yurievich; Skryabina, Anna Aleksandrovna; Sobaih, Badr Hasan; Stortecky, Stefan; Stranges, Saverio; Tadesse, Eyayou Girma; Tarigan, Ingan Ukur; Temsah, Mohamad-Hani; Teuschl, Yvonne; Thrift, Amanda G; Tonelli, Marcello; Tovani-Palone, Marcos Roberto; Tran, Bach Xuan; Tripathi, Manjari; Tsegaye, Gebiyaw Wudie; Ullah, Anayat; Unim, Brigid; Unnikrishnan, Bhaskaran; Vakilian, Alireza; Valadan Tahbaz, Sahel; Vasankari, Tommi Juhani; Venketasubramanian, Narayanaswamy; Vervoort, Dominique; Vo, Bay; Volovici, Victor; Vosoughi, Kia; Vu, Giang Thu; Vu, Linh Gia; Wafa, Hatem A; Waheed, Yasir; Wang, Yanzhong; Wijeratne, Tissa; Winkler, Andrea Sylvia; Wolfe, Charles D A; Woodward, Mark; Wu, Jason H; Wulf Hanson, Sarah; Xu, Xiaoyue; Yadav, Lalit; Yadollahpour, Ali; Yahyazadeh Jabbari, Seyed Hossein; Yamagishi, Kazumasa; Yatsuya, Hiroshi; Yonemoto, Naohiro; Yu, Chuanhua; Yunusa, Ismaeel; Zaman, Muhammed Shahriar; Zaman, Sojib Bin; Zamanian, Maryam; Zand, Ramin; Zandifar, Alireza; Zastrozhin, Mikhail Sergeevich; Zastrozhina, Anasthasia; Zhang, Yunquan; Zhang, Zhi-Jiang; Zhong, Chenwen; Zuniga, Yves Miel H; Murray, Christopher J L;
• Is Part Of: Lancet neurology. Volume 20:Issue 10(2021)
• Page Start: 795
• Page End: 820
• Publication Date: 2021-10
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Nervous System Diseases -- Periodicals; Neurologie -- Périodiques; Neurology; Electronic journals; Periodicals; 616.805
• DOI: 10.1016/S1474-4422(21)00252-0
• Languages: English
• ISSNs: 1474-4422

Abstract

Summary: 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.