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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. Lancet Neurol 2024; 23:973-1003. [PMID: 39304265 DOI: 10.1016/s1474-4422(24)00369-7] [Show More Authors] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/10/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024]
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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Collaborators
Valery L Feigin, Melsew Dagne Abate, Yohannes Habtegiorgis Abate, Samar Abd ElHafeez, Foad Abd-Allah, Ahmed Abdelalim, Atef Abdelkader, Michael Abdelmasseh, Sherief Abd-Elsalam, Parsa Abdi, Arash Abdollahi, Meriem Abdoun, Rami Abd-Rabu, Deldar Morad Abdulah, Auwal Abdullahi, Mesfin Abebe, Roberto Ariel Abeldaño Zuñiga, E S Abhilash, Olugbenga Olusola Abiodun, Olumide Abiodun, Rahim Abo Kasem, Richard Gyan Aboagye, Mohamed Abouzid, Lucas Guimarães Abreu, Woldu Aberhe Abrha, Dariush Abtahi, Samir Abu Rumeileh, Ahmed Abualhasan, Hasan Abualruz, Eman Abu-Gharbieh, Hana J Abukhadijah, Niveen Me Abu-Rmeileh, Salahdein Aburuz, Ahmed Abu-Zaid, Juan Manuel Acuna, Denberu Eshetie Adane, Mesafint Molla Adane, Isaac Yeboah Addo, Rufus Adesoji Adedoyin, Oyelola A Adegboye, Victor Adekanmbi, Kishor Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Leticia Akua Adzigbli, Abdelrahman Yousry Afify, Aanuoluwapo Adeyimika Afolabi, Fatemeh Afrashteh, Muhammad Sohail Afzal, Saira Afzal, Shahin Aghamiri, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Aqeel Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Shahzaib Ahmad, Tauseef Ahmad, Amir Mahmoud Ahmadzade, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Essona Matatom Akara, Rufus Olusola Akinyemi, Mohammed Ahmed Akkaif, Ashley E Akrami, Salah Al Awaidy, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Mohammad Al Qadire, Omar Al Ta'ani, Yazan Al-Ajlouni, Samer O Alalalmeh, Tariq A Alalwan, Ziyad Al-Aly, Rasmieh Mustafa Al-Amer, Wafa A Aldhaleei, Mohammed S Aldossary, Seyedeh Yasaman Alemohammad, Bassam Al-Fatly, Adel Ali Saeed Al-Gheethi, Fadwa Naji Alhalaiqa, Maryam Alharrasi, Abid Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Ali, Waad Ali, Akram Al-Ibraheem, Sheikh Mohammad Alif, Syed Mohamed Aljunid, Wael Almahmeed, Sabah Al-Marwani, Mahmoud A Alomari, Jordi Alonso, Jaber S Alqahtani, Rajaa M Mohammad Al-Raddadi, Ahmad Alrawashdeh, Mohammed A Alsabri, Najim Z Alshahrani, Zaid Altaany, Awais Altaf, Alaa B Al-Tammemi, Diala Altwalbeh, Nelson Alvis-Guzman, Hassan Alwafi, Mohammad Al-Wardat, Yaser Mohammed Al-Worafi, Hany Aly, Safwat Aly, Mohammad Sharif Ibrahim Alyahya, Karem H Alzoubi, Walid Adnan Al-Zyoud, Reza Amani, Prince M Amegbor, Tewodros Getnet Amera, Tarek Tawfik Amin, Alireza Amindarolzarbi, Sohrab Amiri, Hubert Amu, Dickson A Amugsi, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Deanna Anderlini, Dhanalakshmi Angappan, Abhishek Anil, Mohammed Tahir Tahir Ansari, Alireza Ansari-Moghaddam, Rockson Ansong, Saeid Anvari, Saleha Anwar, Sumadi Lukman Anwar, Ekenedilichukwu Emmanuel Anyabolo, Anayochukwu Edward Anyasodor, Geminn Louis Carace Apostol, Francis Appiah, Muhammad Aqeel, Jalal Arabloo, Razman Arabzadeh Bahri, Mosab Arafat, Aleksandr Y Aravkin, Ali Ardekani, Demelash Areda, Brhane Berhe Aregawi, Getnet Mesfin Aregu, Olatunde Aremu, Hidayat Arifin, Johan Ärnlöv, Anton A Artamonov, Judie Arulappan, Umesh Raj Aryal, Zahra Aryan, Akram M Asbeutah, Mulusew A Asemahagn, Mulu Tiruneh Asemu, Mohammad Asghari-Jafarabadi, Mubarek Yesse Ashemo, Tahira Ashraf, Armin Aslani, Haftu Asmerom Asmerom, Thomas Astell-Burt, Seyyed Shamsadin Athari, Prince Atorkey, Maha Moh'd Wahbi Atout, Alok Atreya, Avinash Aujayeb, Marcel Ausloos, Abolfazl Avan, Hamzeh Awad, Adedapo Wasiu Awotidebe, Lemessa Assefa A Ayana, Setognal Birara Aychiluhm, Amdehiwot A Aynalem, Zewdu Bishaw Aynalem, Sina Azadnajafabad, Hiva Azami, Shahkaar Aziz, Ahmed Y Azzam, Abraham Samuel Babu, Giridhara Rathnaiah Babu, Muhammad Badar, Ashish D Badiye, Pegah Bahrami Taghanaki, Saeed Bahramian, Ruhai Bai, Atif Amin Baig, Shankar M Bakkannavar, Abdulaziz T Bako, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Morteza Banakar, Soham Bandyopadhyay, Palash Chandra Banik, Kannu Bansal, Yanping Bao, Miguel A Barboza, Mainak Bardhan, Noel C Barengo, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Amadou Barrow, Lingkan Barua, Azadeh Bashiri, Hameed Akande Bashiru, Afisu Basiru, 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Burkart, Yasser Bustanji, Zahid A Butt, Florentino Luciano Caetano Dos Santos, Luis Alberto Cámera, Luciana Aparecida Campos, Ismael R Campos-Nonato, Fan Cao, Angelo Capodici, Rosario Cárdenas, Sinclair Carr, Giulia Carreras, Andre F Carvalho, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Alberico L Catapano, Maria Sofia Cattaruzza, Luca Cegolon, Francieli Cembranel, Edina Cenko, Ester Cerin, Joshua Chadwick, Chiranjib Chakraborty, Sandip Chakraborty, Jeffrey Shi Kai Chan, Rama Mohan Chandika, Eeshwar K Chandrasekar, Gashaw Sisay Chanie, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Akhilanand Chaurasia, Haowei Chen, Mingling Chen, Simiao Chen, Gerald Chi, Fatemeh Chichagi, Ritesh Chimoriya, Patrick R Ching, Abdulaal Chitheer, So Mi Jemma Cho, Dong-Woo Choi, Bryan Chong, Chean Lin Chong, Hitesh Chopra, Sonali Gajanan Choudhari, Rahul Choudhary, Dinh-Toi Chu, Isaac Sunday Chukwu, Sheng-Chia Chung, Zinhle Cindi, Iolanda Cioffi, Rebecca M 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Doshi, Rajkumar Prakashbhai Doshi, Abdel Douiri, Robert Kokou Dowou, Ashel Chelsea Dsouza, Haneil Larson Dsouza, Viola Savy Dsouza, Bruce B Duncan, Andre Rodrigues Duraes, Arkadiusz Marian Dziedzic, Michael Ekholuenetale, Ibrahim Farahat El Bayoumy, Maysaa El Sayed Zaki, Iffat Elbarazi, Faris El-Dahiyat, Islam Y Elgendy, Muhammed Elhadi, Waseem El-Huneidi, Mohamed A Elmonem, Adel B Elmoselhi, Chadi Eltaha, Theophilus I Emeto, Christopher Imokhuede Esezobor, Negin Esfandiari, Zahra Esmaeili, Francesco Esposito, Mohammad Etoom, Natalia Fabin, Ibtihal Fadhil, Adeniyi Francis Fagbamigbe, Omotayo Francis Fagbule, Shahriar Faghani, Ayesha Fahim, Ildar Ravisovich Fakhradiyev, Luca Falzone, Mohammad Fareed, Jawad Fares, Carla Sofia E Sá Farinha, MoezAlIslam Ezzat Mahmoud Faris, Pawan Sirwan Faris, Mohsen Farjoud Kouhanjani, Andre Faro, Hossein Farrokhpour, Abidemi Omolara Fasanmi, Nelsensius Klau Fauk, Patrick Fazeli, Timur Fazylov, Alireza Feizkhah, Ginenus Fekadu, Xiaoqi Feng, Seyed-Mohammad 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Raggi, Pankaja Raghav Raghav, Pracheth Raghuveer, Fakher Rahim, Md Jillur Rahim, Mahban Rahimifard, Vafa Rahimi-Movaghar, Md Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Nazanin Rahmanian, Vahid Rahmanian, Rahem Rahmati, Setyaningrum Rahmawaty, Gerard Marshall Raj, Sathish Rajaa, Vinoth Rajendran, Pushp Lata Rajpoot, Prashant Rajput, Pradhum Ram, Mahmoud Mohammed Ramadan, Majed Ramadan, Venkitachalam Ramanarayanan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Juwel Rana, Kritika Rana, Rishabh Kumar Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Annemarei Ranta, Mithun Rao, Sowmya J Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Ashkan Rasouli-Saravani, Devarajan Rathish, Santosh Kumar Rauniyar, Salman Rawaf, Christian Razo, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Inayat Ur Rehman, Giuseppe Remuzzi, Nazila Rezaei, Mohsen Rezaeian, Hossein Rezazadeh, Taeho Gregory Rhee, Mavra A Riaz, 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