Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Глобальное, региональное и национальное бремя инсульта, 1990–2016 гг.: систематический анализ в рамках исследования глобального бремени болезней 2016 года
2019-03-11
SCID: 54.1/3q3andgd
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Bayesian meta-regressionGlobal Burden of Disease StudySocio-demographic Indexdisability-adjusted life-yearsstroke burden
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Abstract (AI)
BACKGROUND: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. METHODS: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. FINDINGS: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. INTERPRETATION: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. FUNDING: Bill & Melinda Gates Foundation.
Key Findings
1
Age-standardised stroke incidence decreased in every Socio-demographic Index quintile except the middle-SDI group.
2
Global age-standardised stroke DALY rates decreased by 34.2% between 1990 and 2016 across all Socio-demographic Index quintiles.
3
Global age-standardised stroke mortality declined by 36.2% from 1990 to 2016, with reductions across all Socio-demographic Index quintiles.
4
In 2016, stroke caused 5.5 million deaths and 116.4 million disability-adjusted life-years globally.
5
There were 13.7 million new stroke cases globally in 2016; age-standardised incidence declined by 8.1% since 1990.
Research Object
Stroke (overall, ischaemic stroke, and haemorrhagic stroke) at global, regional, and national levels from 1990 to 2016
Research Subject
Temporal and socioeconomic variation in stroke incidence, prevalence, mortality, YLLs, YLDs, and DALYs across countries and SDI quintiles
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2019-03-11
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