Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study

Valery L Feigin, Rita V Krishnamurthi, Priya Parmar, Bo Norrving, George A Mensah, Derrick A Bennett, Suzanne Barker-Collo, Andrew E Moran, Ralph L Sacco, Thomas Truelsen, Stephen Davis, Jeyaraj Durai Pandian, Mohsen Naghavi, Mohammad H Forouzanfar, Grant Nguyen, Catherine O Johnson, Theo Vos, Atte Meretoja, Christopher J L Murray, Gregory A Roth, GBD 2013 Writing Group, GBD 2013 Stroke Panel Experts Group, Semaw Ferede Abera, Rufus Olusola Akinyemi, Rustam Al-Shahi Salman, Craig S Anderson, Maria Cecilia Bahit, Amitava Banerjee, Sanjay Basu, Norman J Beauchamp, Natan M Bornstein, Michael Brainin, Norberto Luiz Cabral, Ismael Campos-Nonato, Valeria Caso, Ferrán Catalá-López, Rajiv Chowdhury, Hanne K Christensen, Myles D Connor, Gabrielle DeVeber, Samath D Dharmaratne, Klara Dokova, Geoffrey Donnan, Matthias Endres, Jefferson Gomes Fernandes, Fortuné Gankpé, Johanna M Geleijnse, Richard F Gillum, Maurice Giroud, Randah R Hamadeh, Graeme J Hankey, Panniyammakal Jeemon, Jost B Jonas, Dhruv S Kazi, Andre Pascal Kengne, Daniel Kim, Brett M Kissela, Yoshihiro Kokubo, Soewarta Kosen, Michael Kravchenko, Pablo M Lavados, Ming Liu, Paulo A Lotufo, Mark T Mackay, Reza Malekzadeh, Man Mohan Mehndiratta, Yohannes Adama Melaku, Awoke Misganaw, Devina Nand, Michael Piradov, Farshad Pourmalek, Stefano Ricci, David Rojas-Rueda, Nobhojit Roy, Ramesh Sahathevan, Uchechukwu K A Sampson, Nikolay Shalamov, Kevin N Sheth, Yukito Shinohara, Ivy Shiue, Michael Soljak, Luciano A Sposato, Konstantinos Stroumpoulis, David Tanne, Amanda G Thrift, David Lawrence Tirschwell, Yuri Varakin, Narayanaswamy Venketasubramanian, Vasiliy Victorovich Vlassov, Wenzhi Wang, Ronny Westerman, Charles Wolfe, Chuanhua Yu, Kim Yunjin, Maria Cecilia Bahit, Amanda G Thrift, Atte Meretoja, Bill Stavreski, Craig S Anderson, Edwin Pearse, Geoffrey Donnan, Graeme J Hankey, Mark T Mackay, Stephen Davis, Zanfina Ademi, Michael Brainin, Tural Guliyev, Randah R Hamadeh, Heather Harewood, Karen Springer, Iuri da Costa Leite, Jefferson Gomes Fernandes, Norberto Luiz Cabral, Paulo A Lotufo, Klara Dokova, Farshad Pourmalek, Gabrielle deVeber, Luciano A Sposato, M Patrice Lindsay, Patricia M Riccio, Pablo M Lavados, Bin Li, Chuanhua Yu, Guohong Jiang, Jixiang Ma, Maigeng Zhou, Ming Liu, Shankuan Zhu, Wenzhi Wang, Xiaofeng Liang, Yong Zhang, Gabriel Alcalá-Cerra, Hanne K Christensen, Thomas Truelsen, Foad Abd-Allah, Awoke Temesgen, Berhe Weldearegawi Sahle, Semaw Ferede Abera, Yohannes Adama Melaku, Devina Nand, Maurice Giroud, Jost B Jonas, Matthias Endres, Ronny Westerman, Konstantinos Stroumpoulis, Dorairaj Prabhakaran, Jeyaraj Durai Pandian, Man Mohan Mehndiratta, Nobhojit Roy, Panniyammakal Jeemon, Rajeev Gupta, Vasanthan Rajagopalan, Soewarta Kosen, Tati Suryati Warouw, Reza Malekzadeh, Martin J O'Donnell, David Tanne, Natan M Bornstein, Stefano Ricci, Valeria Caso, Yoshihiro Kokubo, Yukito Shinohara, Majed Masoud Asad, Vitalis Kizito Bwire, Sun Ha Jee, Young-Ho Khang, Kim Yunjin, Ramesh Sahathevan, Ismael Campos-Nonato, Fortuné Gankpé, Chaw Yin Myint, Johanna M Geleijnse, Priya Parmar, Rita V Krishnamurthi, Suzanne Barker-Collo, Valery L Feigin, Rufus Olusola Akinyemi, Ole Norheim, Shams Eldin Khalifa, Michael Kravchenko, Michael Piradov, Nikolay Shalamov, Vasiliy Victorovich Vlassov, Yuri Varakin, Jean De Dieu Ngirabega, Jean Pierre Nyemazi, Marie Aimee Muhimpundu, Mohammad Saeedi, Neeraj Bedi, Narayanaswamy Venketasubramanian, Andre Pascal Kengne, David Rojas-Rueda, Ferrán Catalá-López, Samath D Dharmaratne, Bo Norrving, Rasmus Havmoeller, Leo Atwine, Amitava Banerjee, Charles Wolfe, Derrick A Bennett, David K Cundiff, Finbar O'Callaghan, Ivy Shiue, Julia A Critchley, Majid Ezzati, Michael Soljak, Myles D Connor, Peter M Rothwell, Rajiv Chowdhury, Rustam Al-Shahi Salman, William Whiteley, Zhengming Chen, Mercedes Colomar, Adnan M Durrani, Anand Dayama, Andrew E Moran, Awoke Misganaw, Brett M Kissela, Catherine Amlie-Lefond, Catherine O Johnson, Cheng Huang, Christopher J L Murray, Chugh Sumeet, Daniel Kim, David K Cundiff, David Lawrence Tirschwell, Dhruv S Kazi, Dima Qato, Edmond Kato Kabagambe, Eric Ding, Gene Bukhman, Gene Kwan, George A Mensah, George D Thurston, Grant Nguyen, Gregory A Roth, Josef Coresh, Kate Lefondulq, Kevin N Sheth, Matthew A Corriere, Mohammad H Forouzanfar, Mohsen Naghavi, Nana Mainoo, Norman J Beauchamp, Ralph L Sacco, Richard F Gillum, Sanjay Basu, Stephen M Schwartz, Sumeet Chugh, Teresa Fung, Theo Vos, Tim E Byers, Uchechukwu K A Sampson, Walter A Rocca, Warren Lo, Valery L Feigin, Rita V Krishnamurthi, Priya Parmar, Bo Norrving, George A Mensah, Derrick A Bennett, Suzanne Barker-Collo, Andrew E Moran, Ralph L Sacco, Thomas Truelsen, Stephen Davis, Jeyaraj Durai Pandian, Mohsen Naghavi, Mohammad H Forouzanfar, Grant Nguyen, Catherine O Johnson, Theo Vos, Atte Meretoja, Christopher J L Murray, Gregory A Roth, GBD 2013 Writing Group, GBD 2013 Stroke Panel Experts Group, Semaw Ferede Abera, Rufus Olusola Akinyemi, Rustam Al-Shahi Salman, Craig S Anderson, Maria Cecilia Bahit, Amitava Banerjee, Sanjay Basu, Norman J Beauchamp, Natan M Bornstein, Michael Brainin, Norberto Luiz Cabral, Ismael Campos-Nonato, Valeria Caso, Ferrán Catalá-López, Rajiv Chowdhury, Hanne K Christensen, Myles D Connor, Gabrielle DeVeber, Samath D Dharmaratne, Klara Dokova, Geoffrey Donnan, Matthias Endres, Jefferson Gomes Fernandes, Fortuné Gankpé, Johanna M Geleijnse, Richard F Gillum, Maurice Giroud, Randah R Hamadeh, Graeme J Hankey, Panniyammakal Jeemon, Jost B Jonas, Dhruv S Kazi, Andre Pascal Kengne, Daniel Kim, Brett M Kissela, Yoshihiro Kokubo, Soewarta Kosen, Michael Kravchenko, Pablo M Lavados, Ming Liu, Paulo A Lotufo, Mark T Mackay, Reza Malekzadeh, Man Mohan Mehndiratta, Yohannes Adama Melaku, Awoke Misganaw, Devina Nand, Michael Piradov, Farshad Pourmalek, Stefano Ricci, David Rojas-Rueda, Nobhojit Roy, Ramesh Sahathevan, Uchechukwu K A Sampson, Nikolay Shalamov, Kevin N Sheth, Yukito Shinohara, Ivy Shiue, Michael Soljak, Luciano A Sposato, Konstantinos Stroumpoulis, David Tanne, Amanda G Thrift, David Lawrence Tirschwell, Yuri Varakin, Narayanaswamy Venketasubramanian, Vasiliy Victorovich Vlassov, Wenzhi Wang, Ronny Westerman, Charles Wolfe, Chuanhua Yu, Kim Yunjin, Maria Cecilia Bahit, Amanda G Thrift, Atte Meretoja, Bill Stavreski, Craig S Anderson, Edwin Pearse, Geoffrey Donnan, Graeme J Hankey, Mark T Mackay, Stephen Davis, Zanfina Ademi, Michael Brainin, Tural Guliyev, Randah R Hamadeh, Heather Harewood, Karen Springer, Iuri da Costa Leite, Jefferson Gomes Fernandes, Norberto Luiz Cabral, Paulo A Lotufo, Klara Dokova, Farshad Pourmalek, Gabrielle deVeber, Luciano A Sposato, M Patrice Lindsay, Patricia M Riccio, Pablo M Lavados, Bin Li, Chuanhua Yu, Guohong Jiang, Jixiang Ma, Maigeng Zhou, Ming Liu, Shankuan Zhu, Wenzhi Wang, Xiaofeng Liang, Yong Zhang, Gabriel Alcalá-Cerra, Hanne K Christensen, Thomas Truelsen, Foad Abd-Allah, Awoke Temesgen, Berhe Weldearegawi Sahle, Semaw Ferede Abera, Yohannes Adama Melaku, Devina Nand, Maurice Giroud, Jost B Jonas, Matthias Endres, Ronny Westerman, Konstantinos Stroumpoulis, Dorairaj Prabhakaran, Jeyaraj Durai Pandian, Man Mohan Mehndiratta, Nobhojit Roy, Panniyammakal Jeemon, Rajeev Gupta, Vasanthan Rajagopalan, Soewarta Kosen, Tati Suryati Warouw, Reza Malekzadeh, Martin J O'Donnell, David Tanne, Natan M Bornstein, Stefano Ricci, Valeria Caso, Yoshihiro Kokubo, Yukito Shinohara, Majed Masoud Asad, Vitalis Kizito Bwire, Sun Ha Jee, Young-Ho Khang, Kim Yunjin, Ramesh Sahathevan, Ismael Campos-Nonato, Fortuné Gankpé, Chaw Yin Myint, Johanna M Geleijnse, Priya Parmar, Rita V Krishnamurthi, Suzanne Barker-Collo, Valery L Feigin, Rufus Olusola Akinyemi, Ole Norheim, Shams Eldin Khalifa, Michael Kravchenko, Michael Piradov, Nikolay Shalamov, Vasiliy Victorovich Vlassov, Yuri Varakin, Jean De Dieu Ngirabega, Jean Pierre Nyemazi, Marie Aimee Muhimpundu, Mohammad Saeedi, Neeraj Bedi, Narayanaswamy Venketasubramanian, Andre Pascal Kengne, David Rojas-Rueda, Ferrán Catalá-López, Samath D Dharmaratne, Bo Norrving, Rasmus Havmoeller, Leo Atwine, Amitava Banerjee, Charles Wolfe, Derrick A Bennett, David K Cundiff, Finbar O'Callaghan, Ivy Shiue, Julia A Critchley, Majid Ezzati, Michael Soljak, Myles D Connor, Peter M Rothwell, Rajiv Chowdhury, Rustam Al-Shahi Salman, William Whiteley, Zhengming Chen, Mercedes Colomar, Adnan M Durrani, Anand Dayama, Andrew E Moran, Awoke Misganaw, Brett M Kissela, Catherine Amlie-Lefond, Catherine O Johnson, Cheng Huang, Christopher J L Murray, Chugh Sumeet, Daniel Kim, David K Cundiff, David Lawrence Tirschwell, Dhruv S Kazi, Dima Qato, Edmond Kato Kabagambe, Eric Ding, Gene Bukhman, Gene Kwan, George A Mensah, George D Thurston, Grant Nguyen, Gregory A Roth, Josef Coresh, Kate Lefondulq, Kevin N Sheth, Matthew A Corriere, Mohammad H Forouzanfar, Mohsen Naghavi, Nana Mainoo, Norman J Beauchamp, Ralph L Sacco, Richard F Gillum, Sanjay Basu, Stephen M Schwartz, Sumeet Chugh, Teresa Fung, Theo Vos, Tim E Byers, Uchechukwu K A Sampson, Walter A Rocca, Warren Lo

Abstract

Background: Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care.

Objectives: This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013.

Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs).

Results: In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries.

Conclusion: Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority. © 2015 S. Karger AG, Basel.