TY - JOUR

T1 - Global, regional, and national burden of stroke, 1990–2016

T2 - a systematic analysis for the Global Burden of Disease Study 2016

AU - Johnson, Catherine Owens

AU - Nguyen, Minh

AU - Roth, Gregory A.

AU - Nichols, Emma

AU - Alam, Tahiya

AU - Abate, Degu

AU - Abd-Allah, Foad

AU - Abdelalim, Ahmed

AU - Abraha, Haftom Niguse

AU - Abu-Rmeileh, Niveen Me

AU - Adebayo, Oladimeji M.

AU - Adeoye, Abiodun Moshood

AU - Agarwal, Gina

AU - Agrawal, Sutapa

AU - Aichour, Amani Nidhal

AU - Aichour, Ibtihel

AU - Aichour, Miloud Taki Eddine

AU - Alahdab, Fares

AU - Ali, Raghib

AU - Alvis-Guzman, Nelson

AU - Anber, Nahla Hamed

AU - Anjomshoa, Mina

AU - Arabloo, Jalal

AU - Arauz, Antonio

AU - Ärnlöv, Johan

AU - Arora, Amit

AU - Awasthi, Ashish

AU - Banach, Maciej

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Basu, Sanjay

AU - Belachew, Abate Bekele

AU - Belayneh, Yaschilal Muche

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Bhattacharyya, Krittika

AU - Biadgo, Belete

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Bin Sayeed, Muhammad Shahdaat

AU - Butt, Zahid A.

AU - Cahuana-Hurtado, Lucero

AU - Carrero, Juan J.

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Christensen, Hanne

AU - De Courten, Barbora

AU - Ofori-Asenso, Richard

AU - Truelsen, Thomas Clement

AU - GBD 2016 Stroke Collaborators

PY - 2019

Y1 - 2019

N2 - Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation

AB - Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation

U2 - 10.1016/S1474-4422(19)30034-1

DO - 10.1016/S1474-4422(19)30034-1

M3 - Journal article

C2 - 30871944

AN - SCOPUS:85063992632

VL - 18

SP - 439

EP - 458

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 5

ER -