Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Stroke Collaborators, Catherine Owens Johnson, Minh Nguyen, Gregory A Roth, Emma Nichols, Tahiya Alam, Degu Abate, Foad Abd-Allah, Ahmed Abdelalim, Haftom Niguse Abraha, Niveen Me Abu-Rmeileh, Oladimeji M Adebayo, Abiodun Moshood Adeoye, Gina Agarwal, Sutapa Agrawal, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Fares Alahdab, Raghib Ali, Nelson Alvis-Guzman, Nahla Hamed Anber, Mina Anjomshoa, Jalal Arabloo, Antonio Arauz, Johan Ärnlöv, Amit Arora, Ashish Awasthi, Maciej Banach, Miguel A Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Sanjay Basu, Abate Bekele Belachew, Yaschilal Muche Belayneh, Derrick A Bennett, Isabela M Bensenor, Krittika Bhattacharyya, Belete Biadgo, Ali Bijani, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Zahid A Butt, Lucero Cahuana-Hurtado, Juan J Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Ferrán Catalá-López, Yazan Chaiah, Peggy Pei-Chia Chiang, Jee-Young J Choi, Hanne Christensen, Dinh-Toi Chu, Monica Cortinovis, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Kairat Davletov, Barbora de Courten, Vanessa De la Cruz-Góngora, Meaza Girma Degefa, Samath Dhamminda Dharmaratne, Daniel Diaz, Manisha Dubey, Eyasu Ejeta Duken, Dumessa Edessa, Matthias Endres, Emerito Jose A Faraon, Farshad Farzadfar, Eduarda Fernandes, Florian Fischer, Luisa Sorio Flor, Morsaleh Ganji, Abadi Kahsu Gebre, Teklu Gebrehiwo Gebremichael, Birhanu Geta, Kebede Embaye Gezae, Paramjit Singh Gill, Elena V Gnedovskaya, Hector Gómez-Dantés, Alessandra C Goulart, Giuseppe Grosso, Yuming Guo, Rajeev Gupta, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Samer Hamidi, Graeme J Hankey, Hamid Yimam Hassen, Simon I Hay, Mohamed I Hegazy, Behnam Heidari, Nabeel A Herial, Mohammad Ali Hosseini, Sorin Hostiuc, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nader Jahanmehr, Mehdi Javanbakht, Ravi Prakash Jha, Jost B Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Amaha Kahsay, Rizwan Kalani, Yogeshwar Kalkonde, Teshome Abegaz Kamil, Tanuj Kanchan, André Karch, Narges Karimi, Hamidreza Karimi-Sari, Amir Kasaeian, Tesfaye Dessale Kassa, Hossein Kazemeini, Adane Teshome Kefale, Yousef Saleh Khader, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Jagdish Khubchandani, Daniel Kim, Yun Jin Kim, Adnan Kisa, Mika Kivimäki, Ai Koyanagi, Rita K Krishnamurthi, G Anil Kumar, Alessandra Lafranconi, Sarah Lewington, Shanshan Li, Warren David Lo, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Mark T Mackay, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Navid Manafi, Mohammad Ali Mansournia, Man Mohan Mehndiratta, Varshil Mehta, Getnet Mengistu, Atte Meretoja, Tuomo J Meretoja, Bartosz Miazgowski, Tomasz Miazgowski, Ted R Miller, Erkin M Mirrakhimov, Bahram Mohajer, Yousef Mohammad, Milad Mohammadoo-Khorasani, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Yaser Mokhayeri, Ghobad Moradi, Lidia Morawska, Ilais Moreno Velásquez, Seyyed Meysam Mousavi, Oumer Sada S Muhammed, Walter Muruet, Mehdi Naderi, Mohsen Naghavi, Gurudatta Naik, Bruno Ramos Nascimento, Ruxandra Irina Negoi, Cuong Tat Nguyen, Long Hoang Nguyen, Yirga Legesse Nirayo, Bo Norrving, Jean Jacques Noubiap, Richard Ofori-Asenso, Felix Akpojene Ogbo, Andrew T Olagunju, Tinuke O Olagunju, Mayowa Ojo Owolabi, Jeyaraj Durai Pandian, Shanti Patel, Norberto Perico, Michael A Piradov, Suzanne Polinder, Maarten J Postma, Hossein Poustchi, V Prakash, Mostafa Qorbani, Alireza Rafiei, Fakher Rahim, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Muhammad Aziz Rahman, Cesar Reis, Giuseppe Remuzzi, Andre M N Renzaho, Stefano Ricci, Nicholas L S Roberts, Stephen R Robinson, Leonardo Roever, Gholamreza Roshandel, Parisa Sabbagh, Hosein Safari, Saeed Safari, Saeid Safiri, Amirhossein Sahebkar, Saleh Salehi Zahabi, Abdallah M Samy, Paola Santalucia, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Benn Sartorius, Arundhati R Sawant, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Azadeh Shafieesabet, Masood Ali Shaikh, Mehran Shams-Beyranvand, Aziz Sheikh, Kevin N Sheth, Kenji Shibuya, Mika Shigematsu, Min-Jeong Shin, Ivy Shiue, Soraya Siabani, Badr Hasan Sobaih, Luciano A Sposato, Ipsita Sutradhar, P N Sylaja, Cassandra E I Szoeke, Braden James Te Ao, Mohamad-Hani Temsah, Omar Temsah, Amanda G Thrift, Marcello Tonelli, Roman Topor-Madry, Bach Xuan Tran, Khanh Bao Tran, Thomas Clement Truelsen, Afewerki Gebremeskel Tsadik, Irfan Ullah, Olalekan A Uthman, Muthiah Vaduganathan, Pascual R Valdez, Tommi Juhani Vasankari, Rajagopalan Vasanthan, Narayanaswamy Venketasubramanian, Kia Vosoughi, Giang Thu Vu, Yasir Waheed, Elisabete Weiderpass, Kidu Gidey Weldegwergs, Ronny Westerman, Charles D A Wolfe, Dawit Zewdu Wondafrash, Gelin Xu, Ali Yadollahpour, Tomohide Yamada, Hiroshi Yatsuya, Ebrahim M Yimer, Naohiro Yonemoto, Mahmoud Yousefifard, Chuanhua Yu, Zoubida Zaidi, Mohammad Zamani, Afshin Zarghi, Yunquan Zhang, Sanjay Zodpey, Valery L Feigin, Theo Vos, Christopher J L Murray, GBD 2016 Stroke Collaborators, Catherine Owens Johnson, Minh Nguyen, Gregory A Roth, Emma Nichols, Tahiya Alam, Degu Abate, Foad Abd-Allah, Ahmed Abdelalim, Haftom Niguse Abraha, Niveen Me Abu-Rmeileh, Oladimeji M Adebayo, Abiodun Moshood Adeoye, Gina Agarwal, Sutapa Agrawal, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Fares Alahdab, Raghib Ali, Nelson Alvis-Guzman, Nahla Hamed Anber, Mina Anjomshoa, Jalal Arabloo, Antonio Arauz, Johan Ärnlöv, Amit Arora, Ashish Awasthi, Maciej Banach, Miguel A Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Sanjay Basu, Abate Bekele Belachew, Yaschilal Muche Belayneh, Derrick A Bennett, Isabela M Bensenor, Krittika Bhattacharyya, Belete Biadgo, Ali Bijani, Boris Bikbov, Muhammad Shahdaat Bin Sayeed, Zahid A Butt, Lucero Cahuana-Hurtado, Juan J Carrero, Félix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Ferrán Catalá-López, Yazan Chaiah, Peggy Pei-Chia Chiang, Jee-Young J Choi, Hanne Christensen, Dinh-Toi Chu, Monica Cortinovis, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Kairat Davletov, Barbora de Courten, Vanessa De la Cruz-Góngora, Meaza Girma Degefa, Samath Dhamminda Dharmaratne, Daniel Diaz, Manisha Dubey, Eyasu Ejeta Duken, Dumessa Edessa, Matthias Endres, Emerito Jose A Faraon, Farshad Farzadfar, Eduarda Fernandes, Florian Fischer, Luisa Sorio Flor, Morsaleh Ganji, Abadi Kahsu Gebre, Teklu Gebrehiwo Gebremichael, Birhanu Geta, Kebede Embaye Gezae, Paramjit Singh Gill, Elena V Gnedovskaya, Hector Gómez-Dantés, Alessandra C Goulart, Giuseppe Grosso, Yuming Guo, Rajeev Gupta, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Samer Hamidi, Graeme J Hankey, Hamid Yimam Hassen, Simon I Hay, Mohamed I Hegazy, Behnam Heidari, Nabeel A Herial, Mohammad Ali Hosseini, Sorin Hostiuc, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nader Jahanmehr, Mehdi Javanbakht, Ravi Prakash Jha, Jost B Jonas, Jacek Jerzy Jozwiak, Mikk Jürisson, Amaha Kahsay, Rizwan Kalani, Yogeshwar Kalkonde, Teshome Abegaz Kamil, Tanuj Kanchan, André Karch, Narges Karimi, Hamidreza Karimi-Sari, Amir Kasaeian, Tesfaye Dessale Kassa, Hossein Kazemeini, Adane Teshome Kefale, Yousef Saleh Khader, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Jagdish Khubchandani, Daniel Kim, Yun Jin Kim, Adnan Kisa, Mika Kivimäki, Ai Koyanagi, Rita K Krishnamurthi, G Anil Kumar, Alessandra Lafranconi, Sarah Lewington, Shanshan Li, Warren David Lo, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Mark T Mackay, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Navid Manafi, Mohammad Ali Mansournia, Man Mohan Mehndiratta, Varshil Mehta, Getnet Mengistu, Atte Meretoja, Tuomo J Meretoja, Bartosz Miazgowski, Tomasz Miazgowski, Ted R Miller, Erkin M Mirrakhimov, Bahram Mohajer, Yousef Mohammad, Milad Mohammadoo-Khorasani, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Yaser Mokhayeri, Ghobad Moradi, Lidia Morawska, Ilais Moreno Velásquez, Seyyed Meysam Mousavi, Oumer Sada S Muhammed, Walter Muruet, Mehdi Naderi, Mohsen Naghavi, Gurudatta Naik, Bruno Ramos Nascimento, Ruxandra Irina Negoi, Cuong Tat Nguyen, Long Hoang Nguyen, Yirga Legesse Nirayo, Bo Norrving, Jean Jacques Noubiap, Richard Ofori-Asenso, Felix Akpojene Ogbo, Andrew T Olagunju, Tinuke O Olagunju, Mayowa Ojo Owolabi, Jeyaraj Durai Pandian, Shanti Patel, Norberto Perico, Michael A Piradov, Suzanne Polinder, Maarten J Postma, Hossein Poustchi, V Prakash, Mostafa Qorbani, Alireza Rafiei, Fakher Rahim, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Muhammad Aziz Rahman, Cesar Reis, Giuseppe Remuzzi, Andre M N Renzaho, Stefano Ricci, Nicholas L S Roberts, Stephen R Robinson, Leonardo Roever, Gholamreza Roshandel, Parisa Sabbagh, Hosein Safari, Saeed Safari, Saeid Safiri, Amirhossein Sahebkar, Saleh Salehi Zahabi, Abdallah M Samy, Paola Santalucia, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Benn Sartorius, Arundhati R Sawant, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Azadeh Shafieesabet, Masood Ali Shaikh, Mehran Shams-Beyranvand, Aziz Sheikh, Kevin N Sheth, Kenji Shibuya, Mika Shigematsu, Min-Jeong Shin, Ivy Shiue, Soraya Siabani, Badr Hasan Sobaih, Luciano A Sposato, Ipsita Sutradhar, P N Sylaja, Cassandra E I Szoeke, Braden James Te Ao, Mohamad-Hani Temsah, Omar Temsah, Amanda G Thrift, Marcello Tonelli, Roman Topor-Madry, Bach Xuan Tran, Khanh Bao Tran, Thomas Clement Truelsen, Afewerki Gebremeskel Tsadik, Irfan Ullah, Olalekan A Uthman, Muthiah Vaduganathan, Pascual R Valdez, Tommi Juhani Vasankari, Rajagopalan Vasanthan, Narayanaswamy Venketasubramanian, Kia Vosoughi, Giang Thu Vu, Yasir Waheed, Elisabete Weiderpass, Kidu Gidey Weldegwergs, Ronny Westerman, Charles D A Wolfe, Dawit Zewdu Wondafrash, Gelin Xu, Ali Yadollahpour, Tomohide Yamada, Hiroshi Yatsuya, Ebrahim M Yimer, Naohiro Yonemoto, Mahmoud Yousefifard, Chuanhua Yu, Zoubida Zaidi, Mohammad Zamani, Afshin Zarghi, Yunquan Zhang, Sanjay Zodpey, Valery L Feigin, Theo Vos, Christopher J L Murray

Abstract

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.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Age-standardised stroke incidence by country, for both sexes, 2016 ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. VCT=Saint Vincent and the Grenadines. TLS=Timor-Leste. TTO=Trinidad and Tobago.
Figure 2
Figure 2
Global incidence of stroke by age and sex, 2016
Figure 3
Figure 3
Age-standardised rates of YLLs and YLDs due to stroke for both sexes, by age, 2016 YLDs=years lived with disability. YLLs=years of life lost.
Figure 4
Figure 4
Age-standardised DALY rates for stroke versus SDI for both sexes, by region, 1990–2016 Black line shows the expected values by SDI based on a regression of all years of data for all GBD locations between 1990 and 2016. DALY=disability-adjusted life-year. SDI=Socio-demographic Index.

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Source: PubMed

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