Global, Regional, and National Burden of Stroke and Its Risk Factors 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021

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aut.relation.endpage1003
aut.relation.issue10
aut.relation.journalLancet Neurology
aut.relation.startpage973
aut.relation.volume23
dc.contributor.authorFeigin, Valery
dc.contributor.authorNair, B
dc.contributor.authorRautalin, I
dc.contributor.authorBhatia, A
dc.contributor.authorGBD 2021 Stroke Risk Factor Collaborators
dc.date.accessioned2024-09-24T03:36:52Z
dc.date.available2024-09-24T03:36:52Z
dc.date.issued2024
dc.description.abstractBackground 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.
dc.identifier.citationLancet Neurology, ISSN: 1474-4422 (Print); 1474-4465 (Online), Elsevier, 23(10), 973-1003.
dc.identifier.doi10.1016/S1474-4422(24)00369-7
dc.identifier.issn1474-4422
dc.identifier.issn1474-4465
dc.identifier.urihttp://hdl.handle.net/10292/18044
dc.publisherElsevier
dc.relation.urihttps://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00369-7/fulltext
dc.rightsCopyright: © 2024 The Author(s). Published by Elsevier Ltd. User License: Creative Commons Attribution (CC BY 4.0).
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subject1103 Clinical Sciences
dc.subject1109 Neurosciences
dc.subjectNeurology & Neurosurgery
dc.subject3202 Clinical sciences
dc.subject3209 Neurosciences
dc.titleGlobal, Regional, and National Burden of Stroke and Its Risk Factors 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021
dc.typeJournal Article
pubs.elements-id569260
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