Global, regional, and national burden of stroke and its risk factors, 19902019: a systematic analysis for the Global Burden of Disease Study 2019

Abstract

Abstract Background: Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels.

Methods: We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95 uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level.

Findings: In 2019, there were 122 million (95 UI 110-136) incident cases of stroke, 101 million (932-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 655 million (600-702) deaths from stroke. Globally, stroke remained the second-leading cause of death (116 [108-122] of total deaths) and the third-leading cause of death and disability combined (57 [51-62] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 700 (670-730), prevalent strokes increased by 850 (830-880), deaths from stroke increased by 430 (310-550), and DALYs due to stroke increased by 320 (220-420). During the same period, age-standardised rates of stroke incidence decreased by 170 (150-180), mortality decreased by 360 (310-420), prevalence decreased by 60 (50-70), and DALYs decreased by 360 (310-420). However, among people younger than 70 years, prevalence rates increased by 220 (210-240) and incidence rates increased by 150 (120-180). In 2019, the age-standardised stroke-related mortality rate was 36 (35-38) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 37 (35-39) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 624 of all incident strokes in 2019 (763 million [657-896]), while intracerebral haemorrhage constituted 279 (341 million [297-391]) and subarachnoid haemorrhage constituted 97 (118 million [101-139]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 796 million [677-908] DALYs or 555 [482-620] of total stroke DALYs), high body-mass index (349 million [223-486] DALYs or 243 [157-332]), high fasting plasma glucose (289 million [198-415] DALYs or 202 [138-291]), ambient particulate matter pollution (287 million [234-334] DALYs or 201 [166-230]), and smoking (253 million [226-282] DALYs or 176 [164-190]).