Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Abstract

Background Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. Methods We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and agestandardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2 center dot 5th and 97 center dot 5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings In 2021, stroke was the third most common GBD level 3 cause of death (7 center dot 3 million [95% UI 6 center dot 6-7 center dot 8] deaths; 10 center dot 7% [9 center dot 8-11 center dot 3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160 center dot 5 million [147 center dot 8-171 center dot 6] DALYs; 5 center dot 6% [5 center dot 0-6 center dot 1] of all DALYs). In 2021, there were 93 center dot 8 million (89 center dot 0-99 center dot 3) prevalent and 11 center dot 9 million (10 center dot 7-13 center dot 2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65 center dot 3% (62 center dot 4-67 center dot 7), intracerebral haemorrhage constituted 28 center dot 8% (28 center dot 3-28 center dot 8), and subarachnoid haemorrhage constituted 5 center dot 8% (5 center dot 7-6 center dot 0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88 center dot 2% [53 center dot 4-117 center dot 7]), high ambient temperature (72 center dot 4% [51 center dot 1 to 179 center dot 5]), high fasting plasma glucose (32 center dot 1% [26 center dot 7-38 center dot 1]), diet high in sugar-sweetened beverages (23 center dot 4% [12 center dot 7-35 center dot 7]), low physical activity (11 center dot 3% [1 center dot 8-34 center dot 9]), high systolic blood pressure (6 center dot 7% [2 center dot 5-11 center dot 6]), lead exposure (6 center dot 5% [4 center dot 5-11 center dot 2]), and diet low in omega-6 polyunsaturated fatty acids (5 center dot 3% [0 center dot 5-10 center dot 5]). Interpretation Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.