Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

Abstract

Background: There is increasing recognition of stroke as an important contributor to childhood morbidity and mortality. Current estimates of global childhood stroke burden and its temporal trends are sparse. Accurate and up-to-date estimates of childhood stroke burden are important for planning research and the resulting evidence-based strategies for stroke prevention and management. Objectives: To estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013. Methodology: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease 2013 methods. All available data on stroke-related incidence, prevalence, excess mortality and deaths were collected. Statistical models and country-level covariates were employed to produce comprehensive and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. Results: In 2013, there were 97,792 (95% UI 90,564-106,016) prevalent cases of childhood IS and 67,621 (95% UI 62,899-72,214) prevalent cases of childhood HS, reflecting an increase of approximately 35% in the absolute numbers of prevalent childhood strokes since 1990. There were 33,069 (95% UI 28,627-38,998) deaths and 2,615,118 (95% UI 2,265,801-3,090,822) DALYs due to childhood stroke in 2013 globally, reflecting an approximately 200% decrease in the absolute numbers of death and DALYs in childhood stroke since 1990. Between 1990 and 2013, there were significant increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rates for childhood IS and HS decreased significantly in developed countries, a decline was seen only in HS, with no change in prevalence rates of IS, in developing countries. The childhood stroke DALY rates in 2013 were 13.3 (95% UI 10.6-17.1) for IS and 92.7 (95% UI 80.5-109.7) for HS per 100,000. While the prevalence of childhood IS compared to childhood HS was similar globally, the death rate and DALY rate of HS was 6- to 7-fold higher than that of IS. In 2013, the prevalence rate of both childhood IS and HS was significantly higher in developed countries than in developing countries. Conversely, both death and DALY rates for all stroke types were significantly lower in developed countries than in developing countries in 2013. Men showed a trend toward higher childhood stroke death rates (1.5 (1.3-1.8) per 100,000) than women (1.1 (0.9-1.5) per 100,000) and higher childhood stroke DALY rates (120.1 (100.8-143.4) per 100,000) than women (90.9 (74.6-122.4) per 100,000) globally in 2013. Conclusions: Globally, between 1990 and 2013, there was a significa...

The Global Burden of Stroke

“…They also called for new high quality epidemiological studies of stroke in different countries and populations, with a particular emphasis on low- and middle- countries. In addition, an update on stroke prevalence, mortality and DALYs in children and youth [4] as well as in adults aged 20-64 years [5] is provided for ischaemic and haemorrhagic stroke separately by Krishnamurthi et al Barker-Collo et al [6] highlight the higher incidence of ischaemic stroke in men but a lack of sex differences in haemorrhagic stroke incidence or total health loss from stroke as measured by DALYs. They add that well-designed stroke intervention trials that are adequately powered for men and women separately in order to derive robust insights on the effectiveness of stroke interventions are needed.…”

Effect of acupuncture on cerebrovascular reserve in patients with acute cerebral infarction: protocol for a randomized controlled pilot study

“…The global outlook for cerebral infarction is not good [4, 63], and both first- and second-level prevention are critical at reducing the impact of this potentially life-threatening and devastating condition [63–70]. CVR is an independent risk factor for the occurrence [18–21], progression [22–25], and recurrence [26] of cerebral infarction that requires attention.…”

Why Is It Worthwhile to Get Involved in Stroke Organizations?

“…4 In fact, the absolute number of childhood strokes has increased by approximately 35% between 1990 and 2013. 5 The rising stroke incidence in children and young and middle-aged adults requires further attention and improved awareness among health professionals and citizens alike. Better awareness may also promote the adherence to primary prevention strategies among children and young adults.…”