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Global burden of ischemic stroke on the rise
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The global burden of ischemic stroke increased between 1990 and 2010, with the greatest impact observed among low- and middle-income countries, according to new results from the Global Burden of Diseases, Injuries and Risk Factors study.
However, age-standardized mortality rates from ischemic stroke decreased within this time period.
Researchers aimed to summarize findings of the GBD 2010 study for ischemic stroke, and conducted a systematic review which identified 119 evaluable studies of ischemic and total stroke published from 1990 to 2010. They calculated ischemic stroke incidence, mortality rates and disability-adjusted life years lost across 21 regions.
From 1990 to 2010, the global burden of ischemic stroke increased significantly. The absolute number of patients with incident ischemic stroke increased by 37%, deaths related to ischemic stroke increased by 21% and the number of disability-adjusted life years lost increased by 18%.
Researchers observed decreases in the age-standardized incidence of ischemic stroke (13%), mortality (37%) and disability-adjusted life years lost (34%) from 1990 to 2010 in high-income countries. These reductions were significant regardless of age. However, in lower- and middle-income countries, the age-standardized incidence of ischemic stroke increased by 6%, while mortality and the number of disability-adjusted life years lost decreased slightly.
During 2010, an estimated 11,569,000 incident ischemic stroke events occurred, 63% of which occurred in lower- or middle-income countries. An estimated 2,835,000 deaths from ischemic stroke were reported, 57% of which occurred in lower- and middle-income countries. Moreover, approximately 39,389,000 disability-adjusted life years were lost as a result of ischemic stroke.
Estimated total age-standardized incidence rates for ischemic stroke ranged from 51.88 per 100,000 person-years in Qatar to 433.97 per 100,000 person-years in Lithuania during 2010, with age-standardized mortality rates ranging from 9.17 per 100,000 person-years in Qatar to 137.7 per 100,000 person-years in Russia. The lowest incidence rate occurred in Australasia and the highest was observed in Eastern Europe. Mortality was lowest in high-income North America and highest in Eastern Europe.
Mortality rates for ischemic stroke related to tobacco were highest in China (26.2% of observed deaths), Russia (9.9%), Indian (7.3%), the United States (5.3%) and Japan (4.2%) during 1990. In 2010, the countries with the most deaths from ischemic stroke related to tobacco use were China (29.2%), Russia (11.7%), India (10.6%) and Indonesia (4.9%).
"Although age-standardized mortality rates for [ischemic stroke] have decreased in the past two decades, the absolute number of [disability-adjusted life years] lost is increasing, with most of the burden occurring in [low- to middle-income countries]," the researchers concluded. "The primary drivers for this increase include population growth and aging, as well as adverse risk-factor trends. Policy and legislative interventions that target the prevention and control of risk factors can play an important role in addressing the growing [ischemic stroke] burden in [low- to middle-income countries]."
Disclosure: The researchers report no relevant financial disclosures.
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