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Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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.

1474-4422
973-1003
Feigin, Valery L.
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Abate, Melsew Dagne
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Abate, Yohannes Habtegiorgis
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Cao, Fan
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Chong, Bryan
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Esposito, Francesco
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GBD 2021 Stroke Risk Factor Collaborators
Feigin, Valery L.
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Abate, Melsew Dagne
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Abate, Yohannes Habtegiorgis
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Abd-Allah, Foad
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Abdelalim, Ahmed
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Abdelkader, Atef
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Abdelmasseh, Michael
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Abd-Elsalam, Sherief
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Abdi, Parsa
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Abdollahi, Arash
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Abdoun, Meriem
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Abd-Rabu, Rami
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Abdullahi, Auwal
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Abebe, Mesfin
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Abhilash, E.S.
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Abiodun, Olugbenga Olusola
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Abiodun, Olumide
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Aboagye, Richard Gyan
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Abouzid, Mohamed
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Abreu, Lucas Guimarães
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Khan, Mohammad Jobair
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Singh, Abhinav
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Verras, Georgios Ioannis
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Wang, Fang
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Wang, Yuan Pang
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GBD 2021 Stroke Risk Factor Collaborators (2024) Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23 (10), 973-1003. (doi:10.1016/S1474-4422(24)00369-7).

Record type: Article

Abstract

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.

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e-pub ahead of print date: 18 September 2024
Published date: 18 September 2024

Identifiers

Local EPrints ID: 497586
URI: http://eprints.soton.ac.uk/id/eprint/497586
ISSN: 1474-4422
PURE UUID: ab04ec16-106d-4895-8352-8c7c44286cc1
ORCID for Soham Bandyopadhyay: ORCID iD orcid.org/0000-0001-6553-3842
ORCID for Paul H. Lee: ORCID iD orcid.org/0000-0002-5729-6450

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Date deposited: 28 Jan 2025 17:37
Last modified: 29 Jan 2025 03:14

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Contributors

Author: Valery L. Feigin
Author: Melsew Dagne Abate
Author: Yohannes Habtegiorgis Abate
Author: Samar Abd ElHafeez
Author: Foad Abd-Allah
Author: Ahmed Abdelalim
Author: Atef Abdelkader
Author: Michael Abdelmasseh
Author: Sherief Abd-Elsalam
Author: Parsa Abdi
Author: Arash Abdollahi
Author: Meriem Abdoun
Author: Rami Abd-Rabu
Author: Deldar Morad Abdulah
Author: Auwal Abdullahi
Author: Mesfin Abebe
Author: Roberto Ariel Abeldaño Zuñiga
Author: E.S. Abhilash
Author: Olugbenga Olusola Abiodun
Author: Olumide Abiodun
Author: Rahim Abo Kasem
Author: Richard Gyan Aboagye
Author: Mohamed Abouzid
Author: Lucas Guimarães Abreu
Author: Woldu Aberhe Abrha
Author: Dariush Abtahi
Author: Samir Abu Rumeileh
Author: Ahmed Abualhasan
Author: Hasan Abualruz
Author: Eman Abu-Gharbieh
Author: Ahmed Abu-Zaid
Author: Olatunde Aremu
Author: Soham Bandyopadhyay ORCID iD
Author: Fan Cao
Author: Bryan Chong
Author: Theophilus I. Emeto
Author: Francesco Esposito
Author: M. Nuruzzaman Khan
Author: Mohammad Jobair Khan
Author: Paul H. Lee ORCID iD
Author: Seung Won Lee
Author: Wei Chen Lee
Author: Ming Chieh Li
Author: Stephen S. Lim
Author: Md Mosfequr Rahman
Author: Mohammad Hifz Ur Rahman
Author: Abhinav Singh
Author: Georgios Ioannis Verras
Author: Fang Wang
Author: Yuan Pang Wang
Corporate Author: GBD 2021 Stroke Risk Factor Collaborators

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