From 1990 to 2019, the annual number of strokes and stroke-related deaths increased significantly worldwide, with the high body mass index (BMI) being the fastest growing risk factor for stroke during this period, according to Global Burden of Diseases, Injuries. and results of the Risk Factors Study (GBD) published in The Lancet Neurology.
GBD data provides a standardized and comprehensive overview of stroke and its pathological types, risk factors and trends to support evidence-based health policy and resource allocation for stroke. The authors of the current study attempted to provide updated estimates of global, regional, and national exposure to stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage based on the country’s age, gender, and income levels over the past 3 decades. This is the first GBD report that, according to the study authors, presents the global, regional and national exposure to intracerebral hemorrhage and subarachnoid hemorrhage separately.
The current study calculated the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and the population share of DALYs associated with stroke risk factors in 204 countries and territories from 1990 to 2019, including hemorrhage, subarachnoid hemorrhage, and all strokes combined. All estimates were also stratified according to gender, age and income level of the World Bank countries.
The number of stroke incidences, stroke prevalence, DALYs due to stroke, and deaths due to stroke were 12.2 million (95% UI, 11.0-13.6), 101 million (95% UI, 93.2– 111), 143 million (95% UI, 133-153) and 6.55 million (95% UI, 6.00-7.02), respectively. Globally, stroke was the second leading cause of death in 2019 (11.6%; 95% UI 10.8–12.2) and the third leading cause of mortality and disability (5.7%; 95% UI, 5.1–6.2. ). ).
According to the researchers, the absolute number of strokes increased by 70.0% from 1990 to 2019 (95% UI, 67.0-73.0). During the study period, the absolute number of predominant strokes increased by 85.0% (95% UI, 83.0-88.0), and deaths from stroke increased by 43.0% (95% UI, 31.0-55, 0) and DALYs due to stroke increased 32.0% (95% UI, 22.0–42.0).
From 1990 to 2019, the age-standardized stroke incidence rates fell by 17.0% (95% UI, 15.0–18.0), mortality by 36.0% (95% UI, 31.0–42.0) and the prevalence by 6.0% (95% UI.), 5.0–7.0) and DALYs by 36.0% (95% UI, 31.0–42.0). Despite these reductions, the prevalence and incidence rates increased by 22.0% (95% UI, 21.0–24.0) and 15.0% (95% UI, 12.0–18.0), respectively, in people under 70 years of age ) at.
The age-standardized stroke-related death rate in 2019 was about 3.6 (95% UI, 3.5-3.8) higher in the World Bank’s low-income group than in the World Bank’s high-income group. In addition, the age-standardized stroke-related DALY rate in the low-income group was up to 3.7 (95% UI, 3.5–3.9) higher than in the high-income group.
In 2019, 62.4% of all strokes were due to ischemic stroke (7.63 million), 27.9% to intracerebral hemorrhage (3.41 million) and 9.7% to subarachnoid hemorrhage (1.18 million) . The top 5 risk factors for stroke in 2019 included high systolic blood pressure (79.6 million DALYs or 55.5% of total stroke DALYs), high BMI (34.9 million DALYs, or 24.3% of total stroke DALYs ), high fasting plasma glucose (28.9 million DALYs.). or 20.2% of the total stroke DALYs), particulate matter pollution in the environment (28.7 million DALYs or 20.1% of the total stroke DALYs) and smoking (25.3 million DALYs or 17.6% of the total stroke DALYs ).
The study was limited by the lack of other key risk factors for stroke, including atrial fibrillation and substance abuse.
The researchers wrote that “bridging the gaps between high-income and low- and middle-income countries in adapting and implementing internationally recognized guidelines” is “critical to reducing stroke morbidity and mortality with an emphasis on primary prevention strategies”. to address the global stroke burden. “
Disclosure: This clinical study was supported by the Bill & Melinda Gates Foundation. Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.
GBD 2019 stroke staff. Global, regional, and national stroke loads and their risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. Published online September 3, 2021. doi: 10.1016 / S1474-4422 (21) 00252-0