Stroke burden increasing worldwide

Age-standardized rates of stroke mortality declined from 1990 to 2010, but absolute numbers of stroke incidence and other measures have increased during that time, according to a new report.

In particular, people aged 74 years and younger are bearing the majority of the burden of stroke.

If current trends continue, the overall amount of disability and illness and premature death caused by stroke is projected to more than double worldwide by 2030.

For the Global Burden of Diseases, Injuries and Risk Factors Study 2010, researchers analyzed 119 trials to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality and disability-adjusted life-years lost by age group for 1990, 2005 and 2010.

From 1990 to 2010, the age-standardized incidence of stroke decreased by 12% in high-income countries and increased by 12% in low- and middle-income countries.

Burden of stroke

Rates of stroke-related mortality declined from 1990 to 2010 by 37% in high-income countries and 20% in low- and middle-income countries.

However, according to the report, the rates of the following increased from 1990 to 2010:

First stroke, 68% (16.9 million);
Stroke survivors, 84% (33 million);
Stroke-related deaths, 26% (5.9 million); and
Disability-adjusted life-years lost, 12% (102 million).

More than 62% of new strokes, 69.8% of prevalent strokes, 45.5% of deaths from stroke and 71.7% of the disability-adjusted life-years lost because of stroke now occur in people aged younger than 75 years.

“Stroke was traditionally thought of as a disease of elderly people; however, our data show that the proportion of stroke burden is greater overall in individuals younger than 75 years than in those who are older, especially in low-income and middle-income regions,” Valery L. Feigin, MD, PhD, of Auckland University of Technology, New Zealand, and colleagues wrote. A likely factor is the increasing prevalence of diabetes and other CV risk factors in younger people, which indicate the trends will continue if preventive measures are not taken, according to the researchers

By region, the largest increases in stroke incidence occurred in sub-Saharan Africa, the Middle East, Southeast Asia, Central America, Latin America, South Asia and East Asia. The largest decrease occurred in high-income Asia Pacific countries. The largest increases in stroke mortality occurred in sub-Saharan Africa, South Asia, Central America and Latin America. Decreases occurred in North America, Western Europe, Central Europe, North Africa, the Middle East, Australia and high-income Asia Pacific countries. Stroke prevalence was lowest in sub-Saharan Africa, North Africa and the Middle East. The greatest increases in stroke prevalence occurred in North America (1990, 497-750 per 100,000 people; 2010, 595-1,067 per 100,000 people), Western Europe, Eastern Europe, East Asia, Southeast Asia, Australia and high-income Asia Pacific countries.

Urgent measures needed

In a related editorial, Maurice Giroud, MD, Agnès Jacquin, MD, and Yannick Béjot, MD, all of the University of Burgundy, Dijon, France, said the study methods were robust, and the findings raise some alarming issues.

The study “clearly shows that, despite some improvements in stroke prevention and management in high-income countries, the growth and aging of the global population is leading to a rise in the number of young and old patients with stroke,” they wrote. “Urgent preventive measures and acute stroke care should be promoted in low-income and middle-income countries, and the provision of chronic stroke care should be developed worldwide.”

For more information:

Feigin VL. Lancet. 2013;doi:10.1016/S0140-6736(13)61953-4.

Disclosure: The researchers, Béjot, Giroud and Jacquin all report no relevant financial disclosures.