Global and regional burden of stroke during 1990—2010: findings from the Global Burden of Disease Study 2010

Prof Valery L Feigin MD a

, Prof Mohammad H Forouzanfar MD b, Rita Krishnamurthi PhD a, George A Mensah MD c, Myles Connor MBBCh d e f g, Derrick A Bennett PhD h, Prof Andrew E Moran MD i, Prof Ralph L Sacco MD j, Prof Laurie Anderson k, Thomas Truelsen MD l, Prof Martin O'Donnell PhD n, Narayanaswamy Venketasubramanian MBBS o, Prof Suzanne Barker-Collo PhD p, Carlene M M Lawes MBChB q, Prof Wenzhi Wang PhD r, Yukito Shinohara MD s, Emma Witt MSc a, Prof Majid Ezzati PhD m, Prof Mohsen Naghavi MD b, Prof Christopher Murray MD b, on behalf of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group†

Summary

Background

Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990—2010.

Methods

We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specific, pre-specified associations between incidence, prevalence, and mortality, to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 1990="" 2005="" 2010.="" and="" country="" div="" for="" high-income="" in="" income="" level="" low-income="" middle-income="" total="" years="">

Findings

We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke significantly decreased by 12% (95% CI 6—17) in high-income countries, and increased by 12% (—3 to 22) in low-income and middle-income countries, albeit non-significantly. Mortality rates decreased significantly in both high income (37%, 31—41) and low-income and middle-income countries (20%, 15—30). 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 (40%, 46%, 20%, and 16% increase respectively), with most of the burden (68·6% incident strokes, 52·2% prevalent strokes, 70·9% stroke deaths, and 77·7% DALYs lost) in low-income and middle-income countries. In 2010, 5·2 million (31%) strokes were in children (aged <20 45="" 4="" 62="" 69="" 71="" 74="" 75="" additionally="" adults="" almost="" and="" because="" between="" burden.="" burden="" children="" contributed="" countries.="" countries="" dalys="" deaths="" differences="" div="" from="" gbd="" geographical="" in="" lost="" low-income="" middle-aged="" middle-income="" million="" more="" nbsp="" new="" noted="" of="" old="" people="" prevalent="" regions="" respectively="" significant="" stroke="" strokes="" ten="" than="" the="" three="" times="" to="" we="" were="" which="" years.="" years="" young="" younger="">

Interpretation

Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of different income levels.