Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013

The GBD 2013 Study

Valery L. Feigin, Rita V. Krishnamurthi, Priya Parmar, Bo Norrving, George A. Mensah, Derrick A. Bennett, Suzanne Barker-Collo, Andrew E. Moran, Ralph L Sacco, Thomas Truelsen, Stephen Davis, Jeyaraj Durai Pandian, Mohsen Naghavi, Mohammad H. Forouzanfar, Grant Nguyen, Catherine O. Johnson, Theo Vos, Atte Meretoja, Christopher J L Murray, Gregory A. Roth

Research output: Contribution to journalArticle

340 Citations (Scopus)

Abstract

Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. Objectives: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). Results: In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries. Conclusion: Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.

Original languageEnglish (US)
Pages (from-to)161-176
Number of pages16
JournalNeuroepidemiology
Volume45
Issue number3
DOIs
StatePublished - Oct 1 2015

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Stroke
Quality-Adjusted Life Years
Uncertainty
Mortality
Developing Countries
Developed Countries
Survivors
Incidence
Epidemiology

Keywords

  • GBD 2013
  • Global burden
  • Hemorrhagic stroke
  • Ischemic stroke
  • Stroke

ASJC Scopus subject areas

  • Epidemiology
  • Clinical Neurology

Cite this

Feigin, V. L., Krishnamurthi, R. V., Parmar, P., Norrving, B., Mensah, G. A., Bennett, D. A., ... Roth, G. A. (2015). Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology, 45(3), 161-176. https://doi.org/10.1159/000441085

Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013 : The GBD 2013 Study. / Feigin, Valery L.; Krishnamurthi, Rita V.; Parmar, Priya; Norrving, Bo; Mensah, George A.; Bennett, Derrick A.; Barker-Collo, Suzanne; Moran, Andrew E.; Sacco, Ralph L; Truelsen, Thomas; Davis, Stephen; Pandian, Jeyaraj Durai; Naghavi, Mohsen; Forouzanfar, Mohammad H.; Nguyen, Grant; Johnson, Catherine O.; Vos, Theo; Meretoja, Atte; Murray, Christopher J L; Roth, Gregory A.

In: Neuroepidemiology, Vol. 45, No. 3, 01.10.2015, p. 161-176.

Research output: Contribution to journalArticle

Feigin, VL, Krishnamurthi, RV, Parmar, P, Norrving, B, Mensah, GA, Bennett, DA, Barker-Collo, S, Moran, AE, Sacco, RL, Truelsen, T, Davis, S, Pandian, JD, Naghavi, M, Forouzanfar, MH, Nguyen, G, Johnson, CO, Vos, T, Meretoja, A, Murray, CJL & Roth, GA 2015, 'Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study', Neuroepidemiology, vol. 45, no. 3, pp. 161-176. https://doi.org/10.1159/000441085
Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015 Oct 1;45(3):161-176. https://doi.org/10.1159/000441085
Feigin, Valery L. ; Krishnamurthi, Rita V. ; Parmar, Priya ; Norrving, Bo ; Mensah, George A. ; Bennett, Derrick A. ; Barker-Collo, Suzanne ; Moran, Andrew E. ; Sacco, Ralph L ; Truelsen, Thomas ; Davis, Stephen ; Pandian, Jeyaraj Durai ; Naghavi, Mohsen ; Forouzanfar, Mohammad H. ; Nguyen, Grant ; Johnson, Catherine O. ; Vos, Theo ; Meretoja, Atte ; Murray, Christopher J L ; Roth, Gregory A. / Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013 : The GBD 2013 Study. In: Neuroepidemiology. 2015 ; Vol. 45, No. 3. pp. 161-176.
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abstract = "Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. Objectives: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95{\%} uncertainty intervals (UIs). Results: In 2013, there were globally almost 25.7 million stroke survivors (71{\%} with IS), 6.5 million deaths from stroke (51{\%} died from IS), 113 million DALYs due to stroke (58{\%} due to IS) and 10.3 million new strokes (67{\%} IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2{\%} of deaths from stroke and 81.0{\%} of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54{\%} (95{\%} UI 3.11-4.00) and 9.66{\%} (95{\%} UI 8.47-10.70), respectively) to 2013 (4.62{\%} (95{\%} UI 4.01-5.30) and 11.75{\%} (95{\%} UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries. Conclusion: Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.",
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T1 - Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013

T2 - The GBD 2013 Study

AU - Feigin, Valery L.

AU - Krishnamurthi, Rita V.

AU - Parmar, Priya

AU - Norrving, Bo

AU - Mensah, George A.

AU - Bennett, Derrick A.

AU - Barker-Collo, Suzanne

AU - Moran, Andrew E.

AU - Sacco, Ralph L

AU - Truelsen, Thomas

AU - Davis, Stephen

AU - Pandian, Jeyaraj Durai

AU - Naghavi, Mohsen

AU - Forouzanfar, Mohammad H.

AU - Nguyen, Grant

AU - Johnson, Catherine O.

AU - Vos, Theo

AU - Meretoja, Atte

AU - Murray, Christopher J L

AU - Roth, Gregory A.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. Objectives: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). Results: In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries. Conclusion: Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.

AB - Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. Objectives: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). Results: In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries. Conclusion: Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.

KW - GBD 2013

KW - Global burden

KW - Hemorrhagic stroke

KW - Ischemic stroke

KW - Stroke

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