Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study

Abstract

Background: 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.

Targeting stroke risk and improving outcomes in patients with atrial fibrillation in Latin America

“…The Global Burden of Disease (GBD) study estimated that in 2013 there were approximately 26 million stroke survivors worldwide, 71% of whom had experienced ischemic strokes. 1 In the same year, 10.3 million people experienced new strokes (67% consisting of ischemic stroke) and 6.5 million people died from stroke (51% consisting of ischemic stroke). 1 Two-thirds of all strokes occur in low and middle-income countries, 2,3 as categorized by the World Bank, which include most of Latin America.…”

“…1 In the same year, 10.3 million people experienced new strokes (67% consisting of ischemic stroke) and 6.5 million people died from stroke (51% consisting of ischemic stroke). 1 Two-thirds of all strokes occur in low and middle-income countries, 2,3 as categorized by the World Bank, which include most of Latin America. [3][4][5] Continuing studies will help to clarify the complexities of stroke epidemiology.…”

“…10 The GBD investigators noted that agestandardized stroke incidence, mortality, prevalence and strokerelated disability declined from 1990 to 2013. 1 However, over the same period, the absolute number of people affected by stroke increased considerably across the globe, suggesting that the worldwide stroke burden continues to increase due to population growth and aging. 1 Although most of the burden of stroke is borne by low-and middle-income countries, stroke incidence rates have fallen concomitantly with reductions in risk factors associated with stroke therapies in high-income countries.…”

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

“…As the prevalence of AF increases, due partly to the aging population 6 , we would expect more AF-related CE strokes in the future 7 . The Global Burden of Diseases Study Group showed that, from 1990 to 2013, 75% of deaths from strokes and 81% of the stroke-related disability-adjusted life years lost occur in lowand middle-income countries 8 , where the progressive economic pressure of the growing elderly population is occurring 9 . However, little epidemiological data on CE stroke are available from those countries.…”

A Community-Based, Bionic Leg Rehabilitation Program for Patients with Chronic Stroke: Clinical Trial Protocol

“…By 2030, stroke burden is expected to double, with increasing survival rates as medical care and treatment techniques improve (1). This leads to an increasing population with diverse stroke-related disabilities, which may include limitations in communication, activities of daily living, co-ordination, balance and mobility (2).…”