The Global Burden of Ischemic Stroke: Findings of the GBD 2010 Study

Bennett, DA
Krishnamurthi, RV
Barker-Collo, S
Forouzanfar, MH
Naghavi, M
Connor, M
Lawes, CMM
Moran, AE
Anderson, LM
Roth, GA
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Background and objectives: To summarize the findings of The Global Burden of Diseases, Injuries, and Risk Factors (GBD 2010) Study for ischaemic stroke (IS) and report the impact of tobacco smoking on IS burden in specific countries. Methods: The GBD 2010 searched multiple databases to identify relevant studies published between 1990 and 2010. The GBD 2010 analytical tools were used to calculate region-specific IS incidence, mortality, mortality to incidence (MI) ratio and disability-adjusted life years (DALYs) lost, including 95% uncertainty intervals (UI). Findings: In 2010, there were approximately 11,569,000 incident IS events (63% in low- and middleincome countries [LMIC]), approximately 2,835,000 deaths from IS (57% in LMIC), and approximately 39,389,000 DALYs lost due to IS (64% in LMIC).From 1990-2010, there was a significant increase in global IS burden in terms of absolute number of people with incident IS (37% increase), deaths from IS (21% increase) and DALYs lost due to IS (18% increase). Age-standardised IS incidence, DALYs lost, mortality, and MI ratios in HIC declined by about 13% (95% UI 6-18%), 34% (95% UI 16-36%), and 37% (95% UI 19-39%), 21% (95% UI 10-27%), respectively. However, in LMIC there was a modest 6% increase in the age-standardised incidence of IS (95% UI -7%; 18%) despite modest reductions in mortality rates, DALYs lost, and MI ratios. There was considerable variability among country-specific estimates within broad GBD regions. China, Russia and India were ranked highest in both 1990 and 2010 for IS deaths attributable to tobacco consumption. Conclusions: Although age-standardized IS mortality rates have declined over the last two decades, the absolute global burden of IS is increasing, with the bulk of DALYs lost in LMIC. Tobacco consumption is an important modifiable risk factor for IS and in both 1990 and 2010 the top ranked countries for IS deaths that could be attributed to tobacco consumption were China, Russia and India. Tobacco control policies that target both smoking initiation and smoking cessation can play an important role in the prevention of IS. In China, Russia and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone.

Global Heart, 9(1), 107-112.
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