Global and regional burden of stroke during 1990-2010

Findings from the Global Burden of Disease Study 2010

Valery L. Feigin, Mohammad H. Forouzanfar, Rita Krishnamurthi, George A. Mensah, Myles Connor, Derrick A. Bennett, Andrew E. Moran, Ralph L Sacco, Laurie Anderson, Thomas Truelsen, Martin O'Donnell, Narayanaswamy Venketasubramanian, Suzanne Barker-Collo, Carlene M M Lawes, Wenzhi Wang, Yukito Shinohara, Emma Witt, Majid Ezzati, Mohsen Naghavi

Research output: Contribution to journalArticle

1557 Citations (Scopus)

Abstract

Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990.2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specifi c, pre-specifi ed associations between incidence, prevalence, and mortality, to calculate regional and country-specifi c estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 years, .75 years, and in total) and country income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke signifi cantly decreased by 12% (95% CI 6.17) in high-income countries, and increased by 12% (.3 to 22) in low-income and middle-income countries, albeit nonsignifi cantly. Mortality rates decreased signifi cantly in both high income (37%, 31.41) and low-income and middleincome countries (20%, 15.30). In 2010, the absolute numbers of people with fi rst stroke (16-9 million), stroke survivors (33 million), stroke-related deaths (5-9 million), and DALYs lost (102 million) were high and had signifi cantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68-6% incident strokes, 52-2% prevalent strokes, 70-9% stroke deaths, and 77-7% DALYs lost) in low-income and middle-income countries. In 2010, 5-2 million (31%) strokes were in children (aged <20 years old) and young and middle-aged adults (20.64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74 000 (89%) and 4-0 million (78%), respectively, of the burden. Additionally, we noted signifi cant geographical diff erences of between three and ten times in stroke burden between GBD regions and countries. More than 62% of new strokes, 69-8% of prevalent strokes, 45-5% of deaths from stroke, and 71-7% of DALYs lost because of stroke were in people younger than 75 years. Interpretation Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of diff erent income levels.

Original languageEnglish
Pages (from-to)245-255
Number of pages11
JournalThe Lancet
Volume383
Issue number9913
DOIs
StatePublished - Jan 23 2014

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Stroke
Quality-Adjusted Life Years
Global Burden of Disease
Mortality
Incidence
Survivors
Databases
PubMed
Libraries
Cause of Death

ASJC Scopus subject areas

  • Medicine(all)

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Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., ... Naghavi, M. (2014). Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 383(9913), 245-255. https://doi.org/10.1016/S0140-6736(13)61953-4

Global and regional burden of stroke during 1990-2010 : Findings from the Global Burden of Disease Study 2010. / Feigin, Valery L.; Forouzanfar, Mohammad H.; Krishnamurthi, Rita; Mensah, George A.; Connor, Myles; Bennett, Derrick A.; Moran, Andrew E.; Sacco, Ralph L; Anderson, Laurie; Truelsen, Thomas; O'Donnell, Martin; Venketasubramanian, Narayanaswamy; Barker-Collo, Suzanne; Lawes, Carlene M M; Wang, Wenzhi; Shinohara, Yukito; Witt, Emma; Ezzati, Majid; Naghavi, Mohsen.

In: The Lancet, Vol. 383, No. 9913, 23.01.2014, p. 245-255.

Research output: Contribution to journalArticle

Feigin, VL, Forouzanfar, MH, Krishnamurthi, R, Mensah, GA, Connor, M, Bennett, DA, Moran, AE, Sacco, RL, Anderson, L, Truelsen, T, O'Donnell, M, Venketasubramanian, N, Barker-Collo, S, Lawes, CMM, Wang, W, Shinohara, Y, Witt, E, Ezzati, M & Naghavi, M 2014, 'Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010', The Lancet, vol. 383, no. 9913, pp. 245-255. https://doi.org/10.1016/S0140-6736(13)61953-4
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA et al. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. The Lancet. 2014 Jan 23;383(9913):245-255. https://doi.org/10.1016/S0140-6736(13)61953-4
Feigin, Valery L. ; Forouzanfar, Mohammad H. ; Krishnamurthi, Rita ; Mensah, George A. ; Connor, Myles ; Bennett, Derrick A. ; Moran, Andrew E. ; Sacco, Ralph L ; Anderson, Laurie ; Truelsen, Thomas ; O'Donnell, Martin ; Venketasubramanian, Narayanaswamy ; Barker-Collo, Suzanne ; Lawes, Carlene M M ; Wang, Wenzhi ; Shinohara, Yukito ; Witt, Emma ; Ezzati, Majid ; Naghavi, Mohsen. / Global and regional burden of stroke during 1990-2010 : Findings from the Global Burden of Disease Study 2010. In: The Lancet. 2014 ; Vol. 383, No. 9913. pp. 245-255.
@article{dc287d974b6c48e4a9b7daad2a4e4be7,
title = "Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010",
abstract = "Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990.2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specifi c, pre-specifi ed associations between incidence, prevalence, and mortality, to calculate regional and country-specifi c estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 years, .75 years, and in total) and country income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke signifi cantly decreased by 12{\%} (95{\%} CI 6.17) in high-income countries, and increased by 12{\%} (.3 to 22) in low-income and middle-income countries, albeit nonsignifi cantly. Mortality rates decreased signifi cantly in both high income (37{\%}, 31.41) and low-income and middleincome countries (20{\%}, 15.30). In 2010, the absolute numbers of people with fi rst stroke (16-9 million), stroke survivors (33 million), stroke-related deaths (5-9 million), and DALYs lost (102 million) were high and had signifi cantly increased since 1990 (68{\%}, 84{\%}, 26{\%}, and 12{\%} increase, respectively), with most of the burden (68-6{\%} incident strokes, 52-2{\%} prevalent strokes, 70-9{\%} stroke deaths, and 77-7{\%} DALYs lost) in low-income and middle-income countries. In 2010, 5-2 million (31{\%}) strokes were in children (aged <20 years old) and young and middle-aged adults (20.64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74 000 (89{\%}) and 4-0 million (78{\%}), respectively, of the burden. Additionally, we noted signifi cant geographical diff erences of between three and ten times in stroke burden between GBD regions and countries. More than 62{\%} of new strokes, 69-8{\%} of prevalent strokes, 45-5{\%} of deaths from stroke, and 71-7{\%} of DALYs lost because of stroke were in people younger than 75 years. Interpretation Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of diff erent income levels.",
author = "Feigin, {Valery L.} and Forouzanfar, {Mohammad H.} and Rita Krishnamurthi and Mensah, {George A.} and Myles Connor and Bennett, {Derrick A.} and Moran, {Andrew E.} and Sacco, {Ralph L} and Laurie Anderson and Thomas Truelsen and Martin O'Donnell and Narayanaswamy Venketasubramanian and Suzanne Barker-Collo and Lawes, {Carlene M M} and Wenzhi Wang and Yukito Shinohara and Emma Witt and Majid Ezzati and Mohsen Naghavi",
year = "2014",
month = "1",
day = "23",
doi = "10.1016/S0140-6736(13)61953-4",
language = "English",
volume = "383",
pages = "245--255",
journal = "The Lancet",
issn = "0140-6736",
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TY - JOUR

T1 - Global and regional burden of stroke during 1990-2010

T2 - Findings from the Global Burden of Disease Study 2010

AU - Feigin, Valery L.

AU - Forouzanfar, Mohammad H.

AU - Krishnamurthi, Rita

AU - Mensah, George A.

AU - Connor, Myles

AU - Bennett, Derrick A.

AU - Moran, Andrew E.

AU - Sacco, Ralph L

AU - Anderson, Laurie

AU - Truelsen, Thomas

AU - O'Donnell, Martin

AU - Venketasubramanian, Narayanaswamy

AU - Barker-Collo, Suzanne

AU - Lawes, Carlene M M

AU - Wang, Wenzhi

AU - Shinohara, Yukito

AU - Witt, Emma

AU - Ezzati, Majid

AU - Naghavi, Mohsen

PY - 2014/1/23

Y1 - 2014/1/23

N2 - Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990.2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specifi c, pre-specifi ed associations between incidence, prevalence, and mortality, to calculate regional and country-specifi c estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 years, .75 years, and in total) and country income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke signifi cantly decreased by 12% (95% CI 6.17) in high-income countries, and increased by 12% (.3 to 22) in low-income and middle-income countries, albeit nonsignifi cantly. Mortality rates decreased signifi cantly in both high income (37%, 31.41) and low-income and middleincome countries (20%, 15.30). In 2010, the absolute numbers of people with fi rst stroke (16-9 million), stroke survivors (33 million), stroke-related deaths (5-9 million), and DALYs lost (102 million) were high and had signifi cantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68-6% incident strokes, 52-2% prevalent strokes, 70-9% stroke deaths, and 77-7% DALYs lost) in low-income and middle-income countries. In 2010, 5-2 million (31%) strokes were in children (aged <20 years old) and young and middle-aged adults (20.64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74 000 (89%) and 4-0 million (78%), respectively, of the burden. Additionally, we noted signifi cant geographical diff erences of between three and ten times in stroke burden between GBD regions and countries. More than 62% of new strokes, 69-8% of prevalent strokes, 45-5% of deaths from stroke, and 71-7% of DALYs lost because of stroke were in people younger than 75 years. Interpretation Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of diff erent income levels.

AB - Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990.2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specifi c, pre-specifi ed associations between incidence, prevalence, and mortality, to calculate regional and country-specifi c estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 years, .75 years, and in total) and country income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke signifi cantly decreased by 12% (95% CI 6.17) in high-income countries, and increased by 12% (.3 to 22) in low-income and middle-income countries, albeit nonsignifi cantly. Mortality rates decreased signifi cantly in both high income (37%, 31.41) and low-income and middleincome countries (20%, 15.30). In 2010, the absolute numbers of people with fi rst stroke (16-9 million), stroke survivors (33 million), stroke-related deaths (5-9 million), and DALYs lost (102 million) were high and had signifi cantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68-6% incident strokes, 52-2% prevalent strokes, 70-9% stroke deaths, and 77-7% DALYs lost) in low-income and middle-income countries. In 2010, 5-2 million (31%) strokes were in children (aged <20 years old) and young and middle-aged adults (20.64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74 000 (89%) and 4-0 million (78%), respectively, of the burden. Additionally, we noted signifi cant geographical diff erences of between three and ten times in stroke burden between GBD regions and countries. More than 62% of new strokes, 69-8% of prevalent strokes, 45-5% of deaths from stroke, and 71-7% of DALYs lost because of stroke were in people younger than 75 years. Interpretation Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of diff erent income levels.

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