Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
Level 3 - non-randomized controlled study
Epidemiological modeling and observational data synthesis across 204 countries and territories (CEBM level 3 by design analogy).
PubMed 34487721 · doi:10.1016/S1474-4422(21)00252-0
What was done
Using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 analytical tools, researchers calculated stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and population attributable fractions (PAFs) for 19 risk factors across 204 countries and territories from 1990 to 2019. Metrics were estimated for ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, stratified by sex, age group, and World Bank country income level.
What was found
In 2019, there were 12.2 million incident strokes, 101 million prevalent strokes, 6.55 million stroke deaths (11.6% of total global deaths; second-leading cause of death), and 143 million DALYs (5.7% of total DALYs; third-leading cause). From 1990 to 2019, absolute incident cases increased by 70.0%, prevalent cases by 85.0%, deaths by 43.0%, and DALYs by 32.0%, while age-standardised incidence fell by 17.0%, mortality by 36.0%, and DALYs by 36.0%. However, among individuals younger than 70 years, prevalence rates increased by 22.0% and incidence by 15.0%. Age-standardised mortality rates were 3.6 times higher, and DALY rates 3.7 times higher, in World Bank low-income versus high-income countries. Ischaemic stroke accounted for 62.4% of incident cases, intracerebral haemorrhage 27.9%, and subarachnoid haemorrhage 9.7%. In 2019, leading stroke risk factors by attributable DALYs were high systolic blood pressure (55.5% of total stroke DALYs), high body-mass index (24.3%), high fasting plasma glucose (20.2%), ambient particulate matter pollution (20.1%), and smoking (17.6%).
Why it matters
Despite declines in age-standardized rates in older populations, the absolute global volume of strokes and stroke-related deaths continues to rise, driven by population growth, aging, and increasing incidence in adults under 70. The heavy burden in low-income regions and large contribution of modifiable metabolic and environmental risks identify key targets for global prevention.
Limits
The abstract does not state the underlying data source sample sizes or describe data quality and sparsity across low-income regions where statistical imputation is most heavily relied upon. Risk factor attribution relies on observational modeling assumptions rather than prospective interventional validation.
Cited by
- supports Vascular diseases, specifically heart attacks and strokes, are the leading causes of death and permanent disability.