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Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019 Publisher Pubmed



Feigin VL1, 2, 9 ; Stark BA2 ; Johnson CO2 ; Roth GA2, 3, 4 ; Bisignano C2 ; Abady GG10 ; Abbasifard M11, 12 ; Abbasikangevari M16 ; Abdallah F19 ; Abedi V20, 22 ; Abualhasan A19 ; Aburmeileh NME23 ; Abushouk AI24, 33 ; Adebayo OM36 Show All Authors
Authors
  1. Feigin VL1, 2, 9
  2. Stark BA2
  3. Johnson CO2
  4. Roth GA2, 3, 4
  5. Bisignano C2
  6. Abady GG10
  7. Abbasifard M11, 12
  8. Abbasikangevari M16
  9. Abdallah F19
  10. Abedi V20, 22
  11. Abualhasan A19
  12. Aburmeileh NME23
  13. Abushouk AI24, 33
  14. Adebayo OM36
  15. Agarwal G39
  16. Agasthi P41
  17. Ahinkorah BO42
  18. Ahmad S44
  19. Ahmadi S17
  20. Salih YA45, 46
  21. Aji B47
  22. Akbarpour S48
  23. Akinyemi RO55, 61
  24. Al Hamad H62, 63
  25. Alahdab F64
  26. Alif SM65
  27. Alipour V71, 72
  28. Aljunid SM77, 499
  29. Almustanyir S78, 79
  30. Alraddadi RM80
  31. Salman RAS82
  32. Alvisguzman N84, 85
  33. Ancuceanu R86
  34. Anderlini D89, 90
  35. Anderson JA2
  36. Ansar A91, 92
  37. Antonazzo IC93
  38. Arabloo J71
  39. Arnlov J96, 99
  40. Artanti KD100
  41. Aryan Z25, 49
  42. Asgari S18
  43. Ashraf T102
  44. Athar M105, 106
  45. Atreya A107
  46. Ausloos M108, 109
  47. Baig AA110
  48. Baltatu OC111, 112
  49. Banach M113, 114
  50. Barboza MA115, 116
  51. Barkercollo SL117
  52. Barnighausen TW26, 118
  53. Barone MTU120, 121
  54. Basu S27, 122
  55. Bazmandegan G11, 12
  56. Beghi E126
  57. Beheshti M127
  58. Bejot Y128, 129
  59. Bell AW28, 130
  60. Bennett DA131
  61. Bensenor IM132
  62. Bezabhe WM135, 138
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  74. Bryazka D2
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  76. Dos Santos FLC505
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  81. Catapano AL158, 160
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  99. Dandona R2, 4, 186
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  101. Davletov K182
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  105. Dharmaratne SD2, 4, 191
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  166. Humayun A256
  167. Hwang BF257
  168. Iacoviello L174, 259
  169. Iavicoli I260
  170. Ibitoye SE58
  171. Ilesanmi OS37, 59
  172. Ilic IM261
  173. Ilic MD263
  174. Iqbal U264
  175. Irvani SSN265
  176. Islam SMS266, 267
  177. Ismail NE269
  178. Iso H271
  179. Isola G185
  180. Iwagami M272, 274
  181. Jacob L275, 276
  182. Jain V218
  183. Jang SI277
  184. Jayapal SK278
  185. Jayaram S279
  186. Jayawardena R280, 281, 282
  187. Jeemon P284
  188. Jha RP190, 285
  189. Johnson WD286
  190. Jonas JB119, 287
  191. Joseph N154
  192. Jozwiak JJ288
  193. Jurisson M289
  194. Kalani R6
  195. Kalhor R290, 291
  196. Kalkonde Y292
  197. Kamath A250, 252
  198. Kamiab Z12, 13
  199. Kanchan T146
  200. Kandel H268, 293
  201. Karch A294
  202. Katoto PDMC295, 296
  203. Kayode GA297, 298
  204. Keshavarz P299, 300
  205. Khader YS301
  206. Khan EA302
  207. Khan IA303
  208. Khan M304
  209. Khan MAB142, 305
  210. Khatib MN163
  211. Khubchandani J306
  212. Kim GR307
  213. Kim MS309, 310
  214. Kim YJ311
  215. Kisa A312, 313
  216. Kisa S314
  217. Kivimaki M167, 315
  218. Kolte D30, 204
  219. Koolivand A316
  220. Laxminarayana SLK318
  221. Koyanagi A319, 320
  222. Krishan K321
  223. Krishnamoorthy V7, 322
  224. Krishnamurthi RV1
  225. Kumar GA186
  226. Kusuma D123, 323
  227. Vecchia CL159
  228. Lacey B131, 324
  229. Lak HM218
  230. Lallukka T315
  231. Lasrado S325
  232. Lavados PM326, 327
  233. Leonardi M328
  234. Li B329
  235. Li S68
  236. Lin H330
  237. Lin RT258, 331
  238. Liu X219, 332
  239. Lo WD333, 334
  240. Lorkowski S335, 336
  241. Lucchetti G337
  242. Saute RL338
  243. Abd El Razek HM340
  244. Magnani FG328
  245. Mahajan PB341
  246. Majeed A124
  247. Makki A342
  248. Malekzadeh R51, 343
  249. Malik AA81, 104
  250. Manafi N74, 345
  251. Mansournia MA52
  252. Mantovani LG94, 346
  253. Martini S101, 347
  254. Mazzaglia G95
  255. Mehndiratta MM348, 349
  256. Menezes RG350
  257. Meretoja A351, 352
  258. Mersha AG179, 354
  259. Jonasson JM355
  260. Miazgowski B356, 358
  261. Miazgowski T357
  262. Michalek IM359
  263. Mirrakhimov EM360, 361
  264. Mohammad Y362
  265. Mohammadianhafshejani A365
  266. Mohammed S366, 367
  267. Mokdad AH2, 4
  268. Mokhayeri Y368
  269. Molokhia M171
  270. Moni MA369
  271. Al Montasir A370, 371
  272. Moradzadeh R317
  273. Morawska L283
  274. Morze J372
  275. Muruet W170
  276. Musa KI373
  277. Nagarajan AJ374, 375
  278. Naghavi M2, 4
  279. Swamy SN376
  280. Nascimento BR377, 378
  281. Negoi RI88, 379
  282. Kandel SN380
  283. Nguyen TH381, 382
  284. Norrving B383
  285. Noubiap JJ384
  286. Nwatah VE387, 388
  287. Oancea B389
  288. Odukoya OO390, 391
  289. Olagunju AT40, 392
  290. Orru H289, 393
  291. Owolabi MO38, 60
  292. Padubidri JR250
  293. Pana A109, 394
  294. Parekh T395
  295. Park EC307, 308
  296. Kan FP76
  297. Pathak M396
  298. Peres MFP134, 397
  299. Perianayagam A398
  300. Pham TM399
  301. Piradov MA9
  302. Podder V385, 400
  303. Polinder S401
  304. Postma MJ402, 403, 404
  305. Pourshams A51
  306. Radfar A405
  307. Rafiei A406, 407
  308. Raggi A328
  309. Rahim F53, 408
  310. Rahimimovaghar V54
  311. Rahman M91, 409, 410
  312. Rahman MA409
  313. Rahmani AM411
  314. Rajai N31
  315. Ranasinghe P281
  316. Rao CR251
  317. Rao SJ412
  318. Rathi P250
  319. Rawaf DL124, 125, 413
  320. Rawaf S414
  321. Reitsma MB2
  322. Renjith V415
  323. Renzaho AMN416, 417
  324. Rezapour A71
  325. Rodriguez JAB418
  326. Roever L419
  327. Romoli M420, 421
  328. Rynkiewicz A422
  329. Sacco S423
  330. Sadeghi M424
  331. Moghaddam SS49
  332. Sahebkar A426, 427
  333. Saifurrahman KM428, 430
  334. Salah R431, 432
  335. Samaei M433
  336. Samy AM35
  337. Santos IS132, 133
  338. Santricmilicevic MM261, 262
  339. Sarrafzadegan N425, 501
  340. Sathian B62, 434
  341. Sattin D328
  342. Schiavolin S328
  343. Schlaich MP240, 435
  344. Schmidt MI201
  345. Schutte AE436, 440
  346. Sepanlou SG51, 343
  347. Seylani A441
  348. Sha F443
  349. Shahabi S344
  350. Shaikh MA444
  351. Shannawaz M445
  352. Shawon MDSR437
  353. Sheikh A32, 83
  354. Sheikhbahaei S235
  355. Shibuya K446
  356. Siabani S43, 447
  357. Silva DAS448
  358. Singh JA449, 450
  359. Singh JK451
  360. Skryabin VY452
  361. Skryabina AA454
  362. Sobaih BH363, 455
  363. Stortecky S456
  364. Stranges S457, 458
  365. Tadesse EG459
  366. Tarigan IU460
  367. Temsah MH364
  368. Teuschl Y461
  369. Thrift AG69
  370. Tonelli M462
  371. Tovanipalone MR339, 463
  372. Tran BX464
  373. Tripathi M465
  374. Tsegaye GW137
  375. Ullah A466
  376. Unim B467
  377. Unnikrishnan B155
  378. Vakilian A14, 15
  379. Tahbaz SV468, 509
  380. Vasankari TJ469
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  383. Vo B472
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  388. Wafa HA170
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Source: The Lancet Neurology Published:2021


Abstract

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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