Our non-existent stroke leadership will do nothing with this report. NO crash course on solving stroke to 100% recovery. Maybe a few lazy prevention press releases and go back to DOING NOTHING!
Epidemiology and future trend predictions of ischemic stroke based on the global burden of disease study 1990–2021
Communications Medicine 5, Article number: 273 (2025)
Abstract
Background
Visualizing the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 and predicting future disease burdens at global, regional, and national levels can help health policymakers develop evidence-based ischemic stroke (IS) prevention and cure strategies.
Methods
We stratify epidemiological parameters by sex, age, the World Bank’s classification of economies, and sociodemographic index (SDI) levels. We use frontier analysis to assess whether the burden of ischemic stroke (IS) in each country aligns with its level of economic development. We apply the Autoregressive Integrated Moving Average (ARIMA) model and the Bayesian age-period-cohort (BAPC) model to predict the burden of IS over the next 15 years.
Results
Here we show that IS accounts for 69.9 million prevalent cases, 7.8 million incident cases, 3.6 million deaths, and 70.4 million DALYs in 2021. In men, the global DALY rate of IS increases up to age 90–94 years and then decreases; however, for women, the rate increases up to the oldest age group (≥95 years). Regionally, we find that the association between the SDI and the age-standardized DALY rate of IS starts relatively flat, with a small peak up to a sociodemographic index of about 0.7, and then declines rapidly. Factors contributing most to the DALY rates for IS are high systolic blood pressure, high LDL cholesterol, and air pollution.
Conclusions
The disease burden of IS in medium-high SDI countries is still high, which means we could not meet the Sustainable Development Goal targets by 2030. Countries should formulate prevention and control measures suitable for their national conditions based on risk factors.
The plain language summary
Ischemic stroke (IS) occurs when blood flow to part of the brain is reduced or stopped by a blood vessel becoming blocked. We assessed death, prevalence, mortality, disability, and risk factors related to people experiencing IS between 1990 and 2021 in 204 countries and territories and predicted how these might change in the future. Globally, IS accounted for 3.6 million deaths in 2021. Although the frequency of occurrences of IS and deaths due to IS has decreased over the past three decades, the absolute number of ISs is increasing as a result of population growth and population aging. The main risk factors include high systolic blood pressure, high low-density lipoprotein cholesterol, and air pollution. Our data could be useful at the global, regional, and national levels to help health policymakers develop evidence-based IS prevention and care strategies.
Introduction
With aging populations, longer life expectancy, the impact of the COVID-19 pandemic, and changes in the prevalence of NCD risk factors, the global demographic, geographical, and temporal distribution of disease is changing rapidly. According to the GBD 2021 study, stroke is the fourth leading cause of DALYs globally (160.4 million [95% uncertainty intervals 148.0–171.7]), following COVID-19 (212.0 million [198.0–234.5] DALYs), ischaemic heart disease (188.3 million [176.7–198.3]), and neonatal disorders (186.3 million [162.3–214.9])1. Meanwhile, stroke was the third leading cause of deaths globally in 2021, but in 2010 and 1990, stroke was the second leading cause of deaths. In 1990, subarachnoid hemorrhage accounted for 9.66% of all stroke patients, and intracerebral hemorrhage accounted for 22.02% of all stroke patients. Ischemic stroke accounts for about 68.32% of all stroke patients. The following conclusions are drawn from the calculation of the GBD database data over the years. In 2010, subarachnoid hemorrhage accounted for about 8.85%, intracerebral hemorrhage for about 19.83%, and ischemic stroke for about 71.32%. In 2019, subarachnoid hemorrhage accounted for about 8.46%, intracerebral hemorrhage accounted for about 17.66%, and ischemic stroke accounted for about 73.94%. In 2021, subarachnoid hemorrhage accounted for about 8.24%, intracerebral hemorrhage 17.43%, and ischemic stroke 73.33%. IS has been the largest subtype of stroke for more than 30 years. Assessing the trend of ischemic stroke burden over time based on the latest data, the proportion of attributable risk factors, and the relationship between national economic and social development level and disease burden are necessary to guide global, regional, and national health policy formulation.
Ischemic stroke has been regarded as a priority target for the reduction of the burden of NCDs by the United Nations2. The prevention and control measures taken so far are not enough to meet the Sustainable Development Goal targets by 20302. In the context of population aging and widespread chronic disease comorbidities, prevention strategies targeting the latest IS risk factors can significantly improve the epidemiological distribution of IS. The regular and timely updating of the GBD database provides strong data support for the formulation of health strategies that are timely and in line with the latest international situation. Especially in the two years of the COVID-19 epidemic, the impact of COVID-19 on IS was still unknown.
Previous studies reported the most recent stroke burden when GBD data were updated for 2010, 2013, 2017, and 20192,3,4,5,6,7,8,9. In addition, other studies have detailed the burden of STROKE in different age groups in 20134,5. A study based on GBD 2019 calculated the global estimated annual percentage changes (EAPCs) in IS burden by performing linear regression of data and reported Pearson’s correlation coefficient between age-standardized rates of IS and social development index (SDI). Although ischemic stroke is highly prevalent in the elderly, ischemic stroke in young adults is emerging as a new dilemma in low- and middle-income countries2. Another GBD2019 study focused on the growing burden of ischemic stroke among young people in low SDI regions such as North Africa, the Middle East, and Southeast Asia and analyzed risk factors for IS in young adults7. Based on WHO, effective stroke prevention strategies include reducing the risk associated with hypertension (high systolic blood pressure), elevated lipids, diabetes (high fasting plasma glucose), smoking, low physical activity, unhealthy diet, and abdominal obesity (high body mass index [BMI])9. Changing potentially modifiable risk factors above measured in GBD can reduce the burden of stroke effectively.
The Global Burden of Disease 2021 study estimated the burden of 371 diseases and injuries and 88 risk factors from 1990 to 2021 in seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations1,10. During our submission, the GBD Collaboration published a report on the global burden of disease of total stroke and its risk factors and indicated there were 93.8 million (89.0–99.3) prevalent and 11.9 million (10.7–13.2) incident strokes In 2021, there were substantial increases in DALYs attributable to high BMI, high ambient temperature, high fasting plasma glucose, diet high in sugar-sweetened beverages, low physical activity, high systolic blood pressure, lead exposure, and diet low in omega-6 polyunsaturated fatty acids. However, this report does not analyze the World Bank classification and SDI for specific ischemic stroke, nor does it analyze the countries at the forefront of IS management, nor does it use multiple models to predict future trends11. Currently, there are no studies based on GBD 2021 to comprehensively assess the global, regional, and national burden of ischemic stroke stratified by age, sex and the World Bank Income Group Classification, and no studies to conduct frontier analysis of the burden of IS in countries and regions with different SDI stratification to assess the level of health administration and management, and no studies to predict the incidence, prevalence, deaths, and DALYs of IS in the next 15 years by both BAPC and ARIMA models. Besides, we compared the estimated prevalence, incidence, death rate, and DALYs of IS with those that were predicted based on the SDI. We calculated the global EAPCs, which provided annual change about the temporal trends rather than the total percentage change from 1990 to 2021, and offered more accurate information. In particular, we carefully analyzed the distribution of the top-ranked 12 modifiable potential risk factors in different regions, different genders, and different age groups, which is conducive to the development of targeted measures for specific populations on the basis of rigorous statistical data.
Despite global efforts to reduce the burden of IS, disparities persist across countries and regions. Understanding how the IS burden relates to sociodemographic and economic factors is essential for guiding targeted prevention strategies. In this study, we analyze global, regional, and national trends in the incidence, prevalence, mortality, and DALYs of IS, stratified by sex, age, and sociodemographic development. We find that IS accounts for 69.9 million prevalent cases, 7.8 million incident cases, 3.6 million deaths, and 70.4 million DALYs in 2021. The global DALY rate increases with age in both sexes, but declines after age 90–94 in men, while continuing to rise in women aged ≥95 years. We observe that the age-standardized DALY rate initially rises slightly with SDI up to 0.7 and then declines sharply. High systolic blood pressure, elevated LDL cholesterol, and air pollution emerge as the leading contributors to the IS burden. These findings underscore the urgent need for risk-factor-based prevention strategies tailored to national development levels.
Results
Global level
In 2021, 69.9 million (Supplementary Data 1) prevalent cases of ischemic stroke (IS) were published globally, with an age-standardized point prevalence of 819.5 per 100,000, a decrease of 3.5% compared with 1990 (Fig. 1 and Supplementary Data 1). And 7.8 million (Supplementary Data 1) incident cases of ischemic stroke (IS) were reported globally, concerning an age-standardized point incidence of 92.4 per 100,000, a decrease of 15.8% since 1990. IS added up to 3.6 million (Supplementary Data 1) deaths in 2021, with an age-standardized rate of 44.2, a decrease of 39.6% from 1990. In 2021, the case numbers of DALYs for IS globally was 70.4 million (Supplementary Data 1), with a standardized rate of 837.4 DALYs per 100,000, a 34.9% decrease from 1990.
Age-standardized point prevalence of ischemic stroke (IS) per 100,000 population in 2021, by country (n = global dataset). Data are generated from the Global Burden of Disease (GBD) results tool (https://ghdx.healthdata.org/gbd-results-tool). ASPR Age-Standardized Prevalence Rate; IS Ischemic Stroke. The source data for Fig. 1 are provided in Supplementary Data 9. Actual sizes: Prevalence values ranged from 200 to over 1800 per 100,000 population across countries.
No comments:
Post a Comment