Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Catherine O. Johnson(University of Washington), Minh Nguyen(University of Washington), Gregory A. Roth(University of Washington), Emma Nichols(University of Washington), Shazia Alam(University of Washington), Degu Abate(University of Washington), Foad Abd-Allah(University of Washington), Ahmed Abdelalim(University of Washington), Haftom Niguse Abraha(University of Washington), Niveen ME Abu-Rmeileh(University of Washington), Oladimeji Adebayo(University of Washington), Abiodun M. Adeoye(University of Washington), Gina Agarwal(University of Washington), Sutapa Agrawal(University of Washington), Amani Nidhal Aichour(University of Washington), Ibtihel Aichour(University of Washington), Miloud Taki Eddine Aichour(University of Washington), Fares Alahdab(University of Washington), Raghib Ali(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Nahla Anber(University of Washington), Mina Anjomshoa(University of Washington), Jalal Arabloo(University of Washington), Antonio Araúz(University of Washington), Johan Ärnlöv(University of Washington), Amit Arora(University of Washington), Ashish Awasthi(University of Washington), Maciej Banach(University of Washington), Miguel A. Barboza(University of Washington), Suzanne Barker‐Collo(University of Washington), Till Bärnighausen(University of Washington), Sanjay Basu(University of Washington), Abate Bekele Belachew(University of Washington), Yaschilal Muche Belayneh(University of Washington), Derrick Bennett(University of Washington), Isabela M. Benseñor(University of Washington), Krittika Bhattacharyya(University of Washington), Belete Biadgo(University of Washington), Ali Bijani(University of Washington), Boris Bikbov(University of Washington), Muhammad Shahdaat Bin Sayeed(University of Washington), Zahid A Butt(University of Washington), Lucero Cahuana-Hurtado(University of Washington), Juan Jesús Carrero(University of Washington), Félix Carvalho(University of Washington), Carlos A Castañeda-Orjuela(University of Washington), Franz Castro(University of Washington), Ferrán Catalá-López(University of Washington), Yazan Chaiah(University of Washington), Peggy Pei-Chia Chiang(University of Washington), Jee-Young J Choi(University of Washington), Hanne Christensen(University of Washington), Dinh‐Toi Chu(University of Washington), Monica Cortinovis(University of Washington), Albertino Damasceno(University of Washington), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), Ahmad Daryani(University of Washington), Kairat Davletov(University of Washington), Barbora de Courten(University of Washington), Vanessa De la Cruz‐Góngora(University of Washington), Meaza Girma Degefa, Samath Dhamminda Dharmaratne(University of Washington), Daniel Díaz(University of Washington), Manisha Dubey(University of Washington), Eyasu Ejeta Duken(University of Washington), Dumessa Edessa(University of Washington), Matthias Endres(University of Washington), Emerito Jose A Faraon(University of Washington), Farshad Farzadfar(University of Washington), Eduarda Fernandes(University of Washington), Florian Fischer(University of Washington), Luísa Sório Flor(University of Washington), Morsaleh Ganji(University of Washington), Abadi Kahsu Gebre(University of Washington), Teklu Gebrehiwo Gebremichael(University of Washington), Birhanu Geta(University of Washington), Kebede Embaye Gezae(University of Washington), Paramjit Gill(University of Washington), E. V. Gnedovskaya(University of Washington), Hector Gómez‐Dantés(University of Washington), Alessandra C. Goulart(University of Washington), Giuseppe Grosso(University of Washington), Yuming Guo(University of Washington), Rajeev Gupta(University of Washington), Arvin Haj‐Mirzaian(University of Washington), Arya Haj‐Mirzaian(University of Washington), Samer Hamidi(University of Washington), Graeme J. Hankey(University of Washington), Hamid Yimam Hassen(University of Washington), Simon I Hay(University of Washington), Mohamed Hegazy(University of Washington), Behnam Heidari(University of Washington), Nabeel Herial(University of Washington), Mohammad Ali Hosseini(University of Washington), Sorin Hostiuc(University of Washington), Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam(University of Washington), Nader Jahanmehr(University of Washington), Mehdi Javanbakht(University of Washington), Ravi Prakash Jha(University of Washington), Jost B. Jonas(University of Washington), Jacek Jerzy Jozwiak(University of Washington), Mikk Jürisson(University of Washington), Amaha Kahsay(University of Washington), Rizwan Kalani(University of Washington), Yogeshwar Kalkonde(University of Washington), Teshome Abegaz Kamil(University of Washington), Tanuj Kanchan(University of Washington), André Karch(University of Washington), Narges Karimi(University of Washington), Hamidreza Karimi‐Sari(University of Washington), Amir Kasaeian(University of Washington), Tesfaye Kassa(University of Washington), Hossein Kazemeini(University of Washington), Adane Teshome Kefale(University of Washington), Yousef Khader(University of Washington), Ibrahim A. Khalil(University of Washington), Ejaz Ahmad Khan(University of Washington), Young‐Ho Khang(University of Washington), Jagdish Khubchandani(University of Washington), Daniel Kim(University of Washington), Yun Jin Kim(University of Washington), Adnan Kısa(University of Washington), Mika Kivimäki(University of Washington), Ai Koyanagi(University of Washington), Rita Krishnamurthi(University of Washington), G Anil Kumar(University of Washington), Alessandra Lafranconi(University of Washington), Sarah Lewington(University of Washington), Shanshan Li(University of Washington), Warren Lo(University of Washington), Alan D Lopez(University of Washington), Stefan Lorkowski(University of Washington), Paulo A. Lotufo(University of Washington), Mark T. Mackay(University of Washington), Marek Majdán(University of Washington), Reza Majdzadeh(University of Washington), Azeem Majeed(University of Washington), Reza Malekzadeh(University of Washington), Navid Manafi(University of Washington), Mohammad Alì Mansournia(University of Washington), Man Mohan Mehndiratta(University of Washington), Varshil Mehta(University of Washington), Getnet Mengistu(University of Washington), Atte Meretoja(University of Washington), Tuomo J Meretoja(University of Washington), Bartosz Miazgowski(University of Washington), Tomasz Miazgowski(University of Washington), Ted R. Miller(University of Washington), Erkin М Мirrakhimov(University of Washington), Bahram Mohajer(University of Washington), Yousef Mohammad(University of Washington), Milad Khorasani(University of Washington), Shafiu Mohammed(University of Washington), Farnam Mohebi(University of Washington), Ali H. Mokdad(University of Washington), Yaser Mokhayeri(University of Washington), Ghobad Moradi(University of Washington), Lídia Morawska(University of Washington), Ilais Moreno Velásquez(University of Washington), Seyyed Meysam Mousavi(University of Washington), Oumer Sada Muhammed(University of Washington), Walter Muruet-Gutierrez(University of Washington), Mehdi Naderi(University of Washington), Mohsen Naghavi(University of Washington), Gurudatta Naik(University of Washington), Bruno Ramos Nascimento(University of Washington), Ruxandra Irina Negoi, Cuong Tat Nguyen(University of Washington), Long Hoang Nguyen(University of Washington), Yirga Legesse Nirayo(University of Washington), Bo Norrving(University of Washington), Jean Jacques Noubiap(University of Washington), Richard Ofori‐Asenso(University of Washington), Felix Akpojene Ogbo(University of Washington), Andrew T Olagunju(University of Washington), Tinuke O Olagunju(University of Washington), Mayowa Owolabi(University of Washington), Jeyaraj Pandian(University of Washington), Shanti Patel(University of Washington), Norberto Perico(University of Washington), М. А. Пирадов(University of Washington), Suzanne Polinder(University of Washington), Maarten J. Postma(University of Washington), Hossein Poustchi(University of Washington), V. Prakash(University of Washington), Mostafa Qorbani(University of Washington), Alireza Rafiei(University of Washington), Fakher Rahim(University of Washington), Kazem Rahimi(University of Washington), Vafa Rahimi‐Movaghar(University of Washington), Mahfuzar Rahman(University of Washington), Muhammad Aziz Rahman(University of Washington), Cesar Reis(University of Washington), Giuseppe Remuzzi(University of Washington), André M. N. Renzaho(University of Washington), Stefano Ricci(University of Washington), Nicholas L S Roberts(University of Washington), Stephen R. Robinson(University of Washington), Leonardo Roever(University of Washington), Gholamreza Roshandel(University of Washington), Parisa Sabbagh(University of Washington), Hosein Safari(University of Washington), Saeed Safari(University of Washington), Saeid Safiri(University of Washington), Amirhossein Sahebkar(University of Washington), Saleh Salehi Zahabi(University of Washington), Abdallah M Samy(University of Washington), Paola Santalucia(University of Washington), Itamar S Santos(University of Washington), João Vasco Santos(University of Washington), Milena M Santric-Milicevic(University of Washington), Benn Sartorius(University of Washington), Arundhati R Sawant(University of Washington), Aletta E. Schutte(University of Washington), Sadaf G Sepanlou(University of Washington), Azadeh Shafieesabet(University of Washington), Masood Ali Shaikh(University of Washington), Mehran Shams-Beyranvand(University of Washington), Aziz Sheikh(University of Washington), Kevin N. Sheth(University of Washington), Kenji Shibuya(University of Washington), Mika Shigematsu(University of Washington), Min‐Jeong Shin(University of Washington), Ivy Shiue(University of Washington), Soraya Siabani(University of Washington), Badr Hasan Sobaih(University of Washington), Luciano A. Sposato(University of Washington), Ipsita Sutradhar(University of Washington), PN Sylaja(University of Washington), Cassandra Szoeke(University of Washington), Braden Te Ao, Mohamad‐Hani Temsah(University of Washington), Omar Temsah(University of Washington), Amanda G. Thrift(University of Washington), Marcello Tonelli(University of Washington), Roman Topór-Mądry(University of Washington), Bach Xuan Tran(University of Washington), Khanh Bao Tran(University of Washington), Thomas Clement Truelsen(University of Washington), Afewerki Gebremeskel Tsadik(University of Washington), Irfan Ullah(University of Washington), Olalekan A. Uthman(University of Washington), Muthiah Vaduganathan(University of Washington), Pascual Valdéz(University of Washington), Tommi Vasankari(University of Washington), Vasanthan Rajagopalan(University of Washington), Narayanaswamy Venketasubramanian(University of Washington), Kia Vosoughi(University of Washington), Giang Thu Vu(University of Washington), Yasir Waheed(University of Washington), Elisabete Weiderpass(University of Washington), Kidu Gidey Weldegwergs(University of Washington), Ronny Westerman(University of Washington), Charles Wolfe(University of Washington), Dawit Zewdu Wondafrash(University of Washington), Gelin Xu(University of Washington), Ali Yadollahpour(University of Washington), Tomohide Yamada(University of Washington), Hiroshi Yatsuya(University of Washington), Ebrahim M Yimer(University of Washington), Naohiro Yonemoto(University of Washington), Mahmoud Yousefifard(University of Washington), Chuanhua Yu(University of Washington), Zoubida Zaidi(University of Washington), Mohammad Zamani(University of Washington), Afshin Zarghi(University of Washington), Yunquan Zhang(University of Washington), Sanjay Zodpey(University of Washington), Valery L. Feigin(University of Washington), Theo Vos(University of Washington), Christopher J L Murray
Cited by 3,346Open Access
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.
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