Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Глобальное, региональное и национальное бремя инсульта и его факторов риска, 1990–2021 гг.: систематический анализ для исследования «Глобальное бремя болезней», 2021 г.
2024-09-19
SCID: 54.1/9q9mdr7z
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Global Burden of Disease Studyage-standardised ratesdisability-adjusted life-yearsstroke burdenstroke risk factors
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Abstract (AI)
BACKGROUND: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. METHODS: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]). INTERPRETATION: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. FUNDING: Bill & Melinda Gates Foundation.
Key Findings
1
In 2021, stroke caused 7.3 million deaths, representing 10.7% of all global deaths, making it the third-leading GBD level 3 cause of death.
2
Ischaemic stroke represented 65.3% of global strokes in 2021, while intracerebral haemorrhage represented 28.8%.
3
Reductions in stroke incidence stagnated after 2015, with increases in incidence, death, prevalence, and DALY rates in parts of Asia and Oceania, lower-SDI countries, and people younger than 70 years.
4
Stroke accounted for 160.5 million DALYs in 2021, or 5.6% of all global DALYs, ranking fourth among causes.
5
Stroke burden and attributable risk factors varied substantially across regions, countries, territories, and Socio-demographic Index quintiles.
6
The global stroke burden in 2021 included 93.8 million prevalent cases and 11.9 million incident cases.
Research Object
Global, regional, and national stroke burden and its risk factors from 1990 to 2021
Research Subject
Trends and disparities in stroke incidence, prevalence, deaths, DALYs, and attributable burden across stroke types, risk factors, geographical regions, SDI levels, and age groups
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2024-09-19
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