Latest global data shows the chance of stroke is rising, particularly in low- and middle-income countries, with rising incidence amongst younger populations and growing disparities between regions.
Test: Global, regional and national burden of stroke and its risk aspects, 1990–2021: a scientific evaluation for the Global Burden of Disease Study 2021. Image source: ilustrissima/Shutterstock.com
In a recent study published in Lancet Neurologya bunch of researchers presented current global, regional and national estimates of the stroke burden and risk from 1990 to 2021 to tell evidence-based health care and resource allocation.
Background
The Global Burden of Disease (GBD) study shows that the incidence of heart problems, including stroke, has almost doubled from 271 million in 1990 to 523 million in 2019.
Although cardiovascular mortality rates declined within the late twentieth century, this progress has slowed, and in some countries, including Mexico, the UK (UK), and america (US), mortality rates have been increasing since 2010.
The incidence of stroke amongst people under 55 has also increased, as risk aspects akin to hypertension and obesity have increased. Further research is required to trace trends, evaluate interventions, and shape global health strategies for stroke prevention and treatment.
In regards to the study
The GBD 2021 Stroke Burden and Risk Aspects Study used established methodology consistent with previous estimates.
Stroke was defined based on World Health Organization (WHO) clinical criteria and divided into three types: ischemic stroke (blocked blood supply to the brain), intracerebral hemorrhage (bleeding within the brain), and subarachnoid hemorrhage (bleeding between the brain and the brain). coverage).
Relevant registration and surveillance data were used to create independent models for every stroke type to make sure accurate modeling. Stroke incidence and prevalence were modeled using DisMod-MR 2.1, a Bayesian software that takes under consideration various disease parameters.
Death estimates were obtained using explanation for death modeling (CODEm). Data for evaluation included a big selection of sources, including vital signs, oral autopsy, and exposure data.
To evaluate the burden of stroke attributable to the 23 risk aspects, population-based fractions (PAFs) of disability-adjusted life years (DALYs) were calculated. These aspects are divided into 4 categories: environmental, dietary, behavioral and metabolic risks.
The evaluation also took under consideration interactions between risk aspects, including mediation effects in the general calculations.
The study used meta-regression techniques to gather relative risk data and estimate the potential reduction in stroke burden if exposure to risk aspects was at optimal levels. This comprehensive approach stratified estimates by region, age, gender and socio-demographic index (SDI).
Research results
In 2021, global stroke statistics showed 93.8 million stroke survivors, 11.9 million latest stroke cases, 7.3 million stroke-related deaths, and 160.5 million DALYs lost as a result of stroke, accounting for 10, 7% of all deaths and 5.6% of all deaths DALYs from all causes.
Stroke was the third leading explanation for death, after coronary heart disease and coronavirus disease 2019 (COVID-19), and the fourth leading explanation for DALYs. The overwhelming majority of stroke cases, including 83.3% of recent strokes and 87.2% of stroke deaths, occurred in low- and middle-income countries (LMICs), highlighting stark geographic disparities.
Stroke burden varied greatly by region. For instance, Luxembourg has the bottom age-standardized incidence of stroke (57.7 per 100,000), while the Solomon Islands has the best (355.0 per 100,000).
Similarly, Singapore had the bottom stroke death rate (14.2 per 100,000), while North Macedonia had the best (277.4 per 100,000). Significant differences within the burden of stroke were observed between high- and low-income regions, with Central Asia, East Asia and sub-Saharan Africa facing the best stroke burden. In contrast, high-income regions akin to North America and Australasia saw the bottom levels.
When it comes to pathological stroke types, ischemic stroke was probably the most common, accounting for 65.3% of all latest strokes in 2021, followed by intracerebral hemorrhage (28.8%) and subarachnoid hemorrhage (5.8%). Nonetheless, although ischemic stroke is probably the most common variety of stroke, intracerebral hemorrhage accounts for the next percentage of total DALYs (49.6%) in comparison with ischemic stroke (43.8%).
Subarachnoid hemorrhage accounted for six.6% of all stroke-related DALYs. These types also showed distinct geographic and socioeconomic trends. For instance, ischemic strokes accounted for 74.9% of recent strokes in high-income countries, but only 63.4% in LMICs, where intracerebral hemorrhages were more common.
Between 1990 and 2021, the age-standardized incidence, incidence, mortality, and DALY rates of stroke declined worldwide, with probably the most significant declines occurring amongst people aged 70 years and older.
Nonetheless, the variety of strokes, deaths and DALYs increased during this era as a result of population growth and aging. The incidence of stroke amongst people under 70 years of age also showed an increasing trend. The decline in stroke rates has slowed lately, particularly since 2015, with rates stabilizing and even increasing in some regions.
Conclusions
Overall, in 2021, stroke was the second leading explanation for death and the third leading explanation for DALYs amongst non-communicable diseases worldwide. Stroke rates were disproportionately higher in LMICs and lower SDI regions, with intracerebral hemorrhages occurring almost twice as often in LMICs in comparison with high-income countries.
This discrepancy is probably going as a result of the upper prevalence and poorer control of hypertension in LMICs. Although age-standardized stroke rates have declined globally since 1990, the incidence, incidence, and DALYs have increased in Southeast Asia, East Asia, and Oceania since 2015.