Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Valery L. Feigin(Auckland University of Technology), Benjamin Stark(Auckland University of Technology), Catherine O. Johnson(Auckland University of Technology), Gregory A. Roth(Auckland University of Technology), Catherine Bisignano(Auckland University of Technology), Gdiom Gebreheat Abady(Auckland University of Technology), Mitra Abbasifard(Auckland University of Technology), Mohsen Abbasi‐Kangevari(Auckland University of Technology), Foad Abd-Allah(Auckland University of Technology), Vida Abedi(Auckland University of Technology), Ahmed Abualhasan(Auckland University of Technology), Niveen ME Abu-Rmeileh(Auckland University of Technology), Abdelrahman Ibrahim Abushouk(Auckland University of Technology), Oladimeji Adebayo(Auckland University of Technology), Gina Agarwal(Auckland University of Technology), Pradyumna Agasthi(Auckland University of Technology), Bright Opoku Ahinkorah(Auckland University of Technology), Sohail Ahmad(Auckland University of Technology), Sepideh Ahmadi(Auckland University of Technology), Yusra Ahmed Salih(Auckland University of Technology), Budi Aji(Auckland University of Technology), Samaneh Akbarpour(Auckland University of Technology), Rufus Akinyemi(Auckland University of Technology), Hanadi Al Hamad(Auckland University of Technology), Fares Alahdab(Auckland University of Technology), Sheikh Mohammad Alif(Auckland University of Technology), Vahid Alipour(Auckland University of Technology), Syed Mohamed Aljunid(Auckland University of Technology), Sami Almustanyir(Auckland University of Technology), Rajaa Al‐Raddadi(Auckland University of Technology), Rustam Al‐Shahi Salman(Auckland University of Technology), Nelson Alvis‐Guzmán(Auckland University of Technology), Robert Ancuceanu(Auckland University of Technology), Deanna Anderlini(Auckland University of Technology), Jason A Anderson(Auckland University of Technology), Adnan Ansar(Auckland University of Technology), Ippazio Cosimo Antonazzo(Auckland University of Technology), Jalal Arabloo(Auckland University of Technology), Johan Ärnlöv(Auckland University of Technology), Kurnia Dwi Artanti(Auckland University of Technology), Zahra Aryan(Auckland University of Technology), Samaneh Asgari(Auckland University of Technology), Tahira Ashraf(Auckland University of Technology), Mohammad Athar(Auckland University of Technology), Alok Atreya(Auckland University of Technology), Marcel Ausloos(Auckland University of Technology), Atif Amin Baig(Auckland University of Technology), Ovidiu Constantin Baltatu(Auckland University of Technology), Maciej Banach(Auckland University of Technology), Miguel A. Barboza(Auckland University of Technology), Suzanne Barker‐Collo(Auckland University of Technology), Till Bärnighausen(Auckland University of Technology), Mark Thomaz Ugliara Barone(Auckland University of Technology), Sanjay Basu(Auckland University of Technology), Gholamreza Bazmandegan(Auckland University of Technology), Ettore Beghi(Auckland University of Technology), Mahya Beheshti(Auckland University of Technology), Yannick Béjot(Auckland University of Technology), Arielle Wilder Bell(Auckland University of Technology), Derrick Bennett(Auckland University of Technology), Isabela M. Benseñor(Auckland University of Technology), Woldesellassie Bezabhe(Auckland University of Technology), Yihienew Mequanint Bezabih(Auckland University of Technology), Akshaya Srikanth Bhagavathula(Auckland University of Technology), Pankaj Bhardwaj(Auckland University of Technology), Krittika Bhattacharyya(Auckland University of Technology), Ali Bijani(Auckland University of Technology), Boris Bikbov(Auckland University of Technology), Mulugeta Molla Birhanu(Auckland University of Technology), Archith Boloor(Auckland University of Technology), Aimé Bonny(Auckland University of Technology), Michael Bräuer(Auckland University of Technology), Hermann Brenner(Auckland University of Technology), Dana Bryazka(Auckland University of Technology), Zahid A Butt(Auckland University of Technology), Florentino Luciano Caetano dos Santos, Ismael Campos‐Nonato(Auckland University of Technology), Carlos Cantú‐Brito(Auckland University of Technology), Juan Jesús Carrero(Auckland University of Technology), Carlos A Castañeda-Orjuela(Auckland University of Technology), Alberico L. Catapano(Auckland University of Technology), Promit Ananyo Chakraborty(Auckland University of Technology), Jaykaran Charan(Auckland University of Technology), Sonali G Choudhari(Auckland University of Technology), E. Chowdhury(Auckland University of Technology), Dinh‐Toi Chu(Auckland University of Technology), Sheng‐Chia Chung(Auckland University of Technology), David Colozza(Auckland University of Technology), Vera Marisa Costa(Auckland University of Technology), Simona Costanzo(Auckland University of Technology), Michael H Criqui(Auckland University of Technology), Omid Dadras(Auckland University of Technology), Baye Dagnew(Auckland University of Technology), Xiaochen Dai(Auckland University of Technology), Koustuv Dalal(Auckland University of Technology), Albertino Antonio Moura Damasceno(Auckland University of Technology), Emanuele D’Amico(Auckland University of Technology), Lalit Dandona(Auckland University of Technology), Rakhi Dandona(Auckland University of Technology), Jiregna Darega Gela(Auckland University of Technology), Kairat Davletov(Auckland University of Technology), Vanessa De la Cruz‐Góngora(Auckland University of Technology), Rupak Desai(Auckland University of Technology), Deepak Dhamnetiya(Auckland University of Technology), Samath Dhamminda Dharmaratne(Auckland University of Technology), Mandira Lamichhane Dhimal(Auckland University of Technology), Meghnath Dhimal(Auckland University of Technology), Daniel Díaz(Auckland University of Technology), Martin Dichgans(Auckland University of Technology), Клара Докова(Auckland University of Technology), Rajkumar Doshi(Auckland University of Technology), Abdel Douiri(Auckland University of Technology), Bruce Bartholow Duncan(Auckland University of Technology), Sahar Eftekharzadeh(Auckland University of Technology), Michael Ekholuenetale(Auckland University of Technology), Nevine El Nahas(Auckland University of Technology), Islam Y. Elgendy(Auckland University of Technology), Muhammed Elhadi(Auckland University of Technology), Shaimaa I El-Jaafary(Auckland University of Technology), Matthias Endres(Auckland University of Technology), Aman Yesuf Endries(Auckland University of Technology), Daniel Erku(Auckland University of Technology), Emerito Jose A Faraon(Auckland University of Technology), Umar Farooque(Auckland University of Technology), Farshad Farzadfar(Auckland University of Technology), Abdullah Feroze(Auckland University of Technology), Irina Filip(Auckland University of Technology), Florian Fischer(Auckland University of Technology), David Flood(Auckland University of Technology), Mohamed M. Gad(Auckland University of Technology), Shilpa Gaidhane(Auckland University of Technology), Reza Ghanei Gheshlagh(Auckland University of Technology), Ahmad Ghashghaee(Auckland University of Technology), Nermin Ghith(Auckland University of Technology), Ghozali Ghozali(Auckland University of Technology), Sherief Ghozy(Auckland University of Technology), Alessandro Gialluisi(Auckland University of Technology), Simona Giampaoli(Auckland University of Technology), Syed Amir Gilani(Auckland University of Technology), Paramjit Gill(Auckland University of Technology), E. V. Gnedovskaya(Auckland University of Technology), Mahaveer Golechha(Auckland University of Technology), Alessandra C. Goulart(Auckland University of Technology), Yuming Guo(Auckland University of Technology), Rajeev Gupta(Auckland University of Technology), Veer Bala Gupta(Auckland University of Technology), Vivek Gupta(Auckland University of Technology), Pradip Gyanwali(Auckland University of Technology), Nima Hafezi‐Nejad(Auckland University of Technology), Samer Hamidi(Auckland University of Technology), Asif Hanif(Auckland University of Technology), Graeme J. Hankey(Auckland University of Technology), Arief Hargono(Auckland University of Technology), Abdiwahab Hashi(Auckland University of Technology), Treska S Hassan(Auckland University of Technology), Hamid Yimam Hassen(Auckland University of Technology), Rasmus Havmoeller(Auckland University of Technology), Simon I Hay(Auckland University of Technology), Khezar Hayat(Auckland University of Technology), Mohamed Hegazy(Auckland University of Technology), Claudiu Herţeliu(Auckland University of Technology), Ramesh Holla(Auckland University of Technology), Sorin Hostiuc(Auckland University of Technology), Mowafa Househ(Auckland University of Technology), Junjie Huang(Auckland University of Technology), Ayesha Humayun(Auckland University of Technology), Bing‐Fang Hwang(Auckland University of Technology), Licia Iacoviello(Auckland University of Technology), Ivo Iavicoli(Auckland University of Technology), Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi(Auckland University of Technology), Irena Ilić(Auckland University of Technology), Milena Ilić(Auckland University of Technology), Usman Iqbal(Auckland University of Technology), Seyed Sina Naghibi Irvani(Auckland University of Technology), Sheikh Mohammed Shariful Islam(Auckland University of Technology), Nahlah Elkudssiah Ismail(Auckland University of Technology), Hiroyasu Iso(Auckland University of Technology), Gaetano Isola(Auckland University of Technology), Masao Iwagami(Auckland University of Technology), Louis Jacob(Auckland University of Technology), Vardhmaan Jain(Auckland University of Technology), Sung‐In Jang(Auckland University of Technology), Sathish Kumar Jayapal(Auckland University of Technology), Shubha Jayaram(Auckland University of Technology), Ranil Jayawardena(Auckland University of Technology), Panniyammakal Jeemon(Auckland University of Technology), Ravi Prakash Jha(Auckland University of Technology), Walter D. Johnson(Auckland University of Technology), Jost B Jonas(Auckland University of Technology), Nitin Joseph(Auckland University of Technology), Jacek Jerzy Jozwiak(Auckland University of Technology), Mikk Jürisson(Auckland University of Technology), Rizwan Kalani(Auckland University of Technology), Rohollah Kalhor(Auckland University of Technology), Yogeshwar Kalkonde(Auckland University of Technology), Ashwin Kamath(Auckland University of Technology), Zahra Kamiab(Auckland University of Technology), Tanuj Kanchan(Auckland University of Technology), Himal Kandel(Auckland University of Technology), André Karch(Auckland University of Technology), Patrick DMC Katoto(Auckland University of Technology), Gbenga A Kayode(Auckland University of Technology), Pedram Keshavarz(Auckland University of Technology), Yousef Khader(Auckland University of Technology), Ejaz Ahmad Khan(Auckland University of Technology), Imteyaz Ahmad Khan(Auckland University of Technology), Maseer Khan(Auckland University of Technology), Moien AB Khan(Auckland University of Technology), Mahalaqua Nazli Khatib(Auckland University of Technology), Jagdish Khubchandani(Auckland University of Technology), Gyu Ri Kim(Auckland University of Technology), Min Seo Kim(Auckland University of Technology), Yun Jin Kim(Auckland University of Technology), Adnan Kısa(Auckland University of Technology), Sezer Kısa(Auckland University of Technology), Mika Kivimäki(Auckland University of Technology), Dhaval Kolte(Auckland University of Technology), Ali Koolivand(Auckland University of Technology), Sindhura Lakshmi Koulmane Laxminarayana(Auckland University of Technology), Ai Koyanagi(Auckland University of Technology), Kewal Krishan(Auckland University of Technology), Vijay Krishnamoorthy(Auckland University of Technology), Rita Krishnamurthi(Auckland University of Technology), G Anil Kumar(Auckland University of Technology), Dian Kusuma(Auckland University of Technology), Carlo La Vecchia(Auckland University of Technology), Ben Lacey(Auckland University of Technology), Hassan Mehmood Lak(Auckland University of Technology), Tea Lallukka(Auckland University of Technology), Savita Lasrado(Auckland University of Technology), Pablo M Lavados(Auckland University of Technology), Matilde Leonardi(Auckland University of Technology), Bingyu Li(Auckland University of Technology), Shanshan Li(Auckland University of Technology), Hualiang Lin(Auckland University of Technology), Ro‐Ting Lin(Auckland University of Technology), Xuefeng Liu(Auckland University of Technology), Warren Lo(Auckland University of Technology), Stefan Lorkowski(Auckland University of Technology), Giancarlo Lucchetti(Auckland University of Technology), Ricardo Lutzky Saute(Auckland University of Technology), Hassan Magdy Abd El Razek(Auckland University of Technology), Francesca Giulia Magnani(Auckland University of Technology), Preetam Mahajan(Auckland University of Technology), Azeem Majeed(Auckland University of Technology), Alaa Makki(Auckland University of Technology), Reza Malekzadeh(Auckland University of Technology), Ahmad Azam Malik(Auckland University of Technology), Navid Manafi(Auckland University of Technology), Mohammad Alì Mansournia(Auckland University of Technology), LG Mantovani(Auckland University of Technology), Santi Martini(Auckland University of Technology), Giampiero Mazzaglia(Auckland University of Technology), Man Mohan Mehndiratta(Auckland University of Technology), Ritesh G. Menezes(Auckland University of Technology), Atte Meretoja(Auckland University of Technology), Amanual Getnet Mersha(Auckland University of Technology), Junmei Miao Jonasson(Auckland University of Technology), Bartosz Miazgowski(Auckland University of Technology), Tomasz Miazgowski(Auckland University of Technology), Irmina Maria Michałek(Auckland University of Technology), Erkin М Мirrakhimov(Auckland University of Technology), Yousef Mohammad(Auckland University of Technology), Abdollah Mohammadian-Hafshejani(Auckland University of Technology), Shafiu Mohammed(Auckland University of Technology), Ali H. Mokdad(Auckland University of Technology), Yaser Mokhayeri(Auckland University of Technology), Mariam Molokhia(Auckland University of Technology), Mohammad Ali Moni(Auckland University of Technology), Ahmed Al Montasir(Auckland University of Technology), Rahmatollah Moradzadeh(Auckland University of Technology), Lídia Morawska(Auckland University of Technology), Jakub Morze(Auckland University of Technology), Walter Muruet-Gutierrez(Auckland University of Technology), Kamarul Imran Musa(Auckland University of Technology), Ahamarshan Jayaraman Nagarajan(Auckland University of Technology), Mohsen Naghavi(Auckland University of Technology), Sreenivas Narasimha Swamy(Auckland University of Technology), Bruno Ramos Nascimento, Ruxandra Irina Negoi, Sandhya Neupane Kandel(Auckland University of Technology), Trang Huyen Nguyen(Auckland University of Technology), Bo Norrving(Auckland University of Technology), Jean Jacques Noubiap(Auckland University of Technology), Vincent Ebuka Nwatah(Auckland University of Technology), Bogdan Oancea(Auckland University of Technology), Oluwakemi Ololade Odukoya(Auckland University of Technology), Andrew T Olagunju(Auckland University of Technology), Hans Orru(Auckland University of Technology), Mayowa Owolabi(Auckland University of Technology), Jagadish Rao Padubidri(Auckland University of Technology), Adrian Pană(Auckland University of Technology), Tarang Parekh(Auckland University of Technology), Eun‐Cheol Park(Auckland University of Technology), Fatemeh Pashazadeh Kan, Mona Pathak(Auckland University of Technology), Mário Fernando Prieto Peres(Auckland University of Technology), Arokiasamy Perianayagam(Auckland University of Technology), Truong‐Minh Pham(Auckland University of Technology), М. А. Пирадов(Auckland University of Technology), Vivek Podder(Auckland University of Technology), Suzanne Polinder(Auckland University of Technology), Maarten J. Postma(Auckland University of Technology), Akram Pourshams(Auckland University of Technology), Amir Radfar(Auckland University of Technology), Alireza Rafiei(Auckland University of Technology), Alberto Raggi(Auckland University of Technology), Fakher Rahim(Auckland University of Technology), Vafa Rahimi‐Movaghar(Auckland University of Technology), Mosiur Rahman(Auckland University of Technology), Muhammad Aziz Rahman(Auckland University of Technology), Amir Masoud Rahmani(Auckland University of Technology), Nazanin Rajai(Auckland University of Technology), Priyanga Ranasinghe(Auckland University of Technology), Chythra R Rao(Auckland University of Technology), Sowmya J Rao(Auckland University of Technology), Priya Rathi(Auckland University of Technology), David Laith Rawaf(Auckland University of Technology), Salman Rawaf(Auckland University of Technology), Marissa B Reitsma(Auckland University of Technology), Vishnu Renjith(Auckland University of Technology), André M. N. Renzaho(Auckland University of Technology), Aziz Rezapour(Auckland University of Technology), Jefferson Antonio Buendía(Auckland University of Technology), Leonardo Roever(Auckland University of Technology), Michele Romoli(Auckland University of Technology), Andrzej Rynkiewicz(Auckland University of Technology), Simona Sacco(Auckland University of Technology), Masoumeh Sadeghi(Auckland University of Technology), Sahar Saeedi Moghaddam(Auckland University of Technology), Amirhossein Sahebkar(Auckland University of Technology), KM Saif‐Ur‐Rahman(Auckland University of Technology), Rehab Salah(Auckland University of Technology), Mehrnoosh Samaei(Auckland University of Technology), Abdallah M Samy(Auckland University of Technology), Itamar S Santos(Auckland University of Technology), Milena M Santric-Milicevic(Auckland University of Technology), Nizal Sarrafzadegan(Auckland University of Technology), Brijesh Sathian(Auckland University of Technology), Davide Sattin(Auckland University of Technology), Silvia Schiavolin(Auckland University of Technology), Markus P. Schlaich(Auckland University of Technology), María Inês Schmidt(Auckland University of Technology), Aletta E. Schutte(Auckland University of Technology), Sadaf G Sepanlou(Auckland University of Technology), Allen Seylani(Auckland University of Technology), Feng Sha(Auckland University of Technology), Saeed Shahabi(Auckland University of Technology), Masood Ali Shaikh(Auckland University of Technology), Mohammed Shannawaz(Auckland University of Technology), Md Shajedur Rahman Shawon(Auckland University of Technology), Aziz Sheikh(Auckland University of Technology), Sara Sheikhbahaei(Auckland University of Technology), Kenji Shibuya(Auckland University of Technology), Soraya Siabani(Auckland University of Technology), Diego Augusto Santos Silva(Auckland University of Technology), Jasvinder A. Singh(Auckland University of Technology), Jitendra Kumar Singh(Auckland University of Technology), Valentin Yurievich Skryabin(Auckland University of Technology), Anna Aleksandrovna Skryabina(Auckland University of Technology), Badr Hasan Sobaih(Auckland University of Technology), Stefan Stortecky(Auckland University of Technology), Saverio Stranges(Auckland University of Technology), Eyayou Girma Tadesse(Auckland University of Technology), Ingan Ukur Tarigan(Auckland University of Technology), Mohamad‐Hani Temsah(Auckland University of Technology), Yvonne Teuschl(Auckland University of Technology), Amanda G. Thrift(Auckland University of Technology), Marcello Tonelli(Auckland University of Technology), Marcos Roberto Tovani‐Palone, Bach Xuan Tran(Auckland University of Technology), Manjari Tripathi(Auckland University of Technology), Gebiyaw Wudie Tsegaye(Auckland University of Technology), Anayat Ullah(Auckland University of Technology), Brigid Unim(Auckland University of Technology), Bhaskaran Unnikrishnan(Auckland University of Technology), Alireza Vakilian(Auckland University of Technology), Sahel Valadan Tahbaz(Auckland University of Technology), Tommi Vasankari(Auckland University of Technology), Narayanaswamy Venketasubramanian(Auckland University of Technology), Dominique Vervoort(Auckland University of Technology), Bay Vo(Auckland University of Technology), Victor Volovici(Auckland University of Technology), Kia Vosoughi(Auckland University of Technology), Giang Thu Vu(Auckland University of Technology), Linh Gia Vu(Auckland University of Technology), Hatem A Wafa(Auckland University of Technology), Yasir Waheed(Auckland University of Technology), Yanzhong Wang(Auckland University of Technology), Tissa Wijeratne(Auckland University of Technology), Andrea Sylvia Winkler(Auckland University of Technology), Charles Wolfe(Auckland University of Technology), Mark Woodward(Auckland University of Technology), Jason Wu(Auckland University of Technology), Sarah Wulf Hanson(Auckland University of Technology), Xiaoyue Xu(Auckland University of Technology), Lalit Yadav(Auckland University of Technology), Ali Yadollahpour(Auckland University of Technology), Seyed Hossein Yahyazadeh Jabbari(Auckland University of Technology), Kazumasa Yamagishi(Auckland University of Technology), Hiroshi Yatsuya(Auckland University of Technology), Naohiro Yonemoto(Auckland University of Technology), Chuanhua Yu(Auckland University of Technology), Ismaeel Yunusa(Auckland University of Technology), Muhammed Shahriar Zaman(Auckland University of Technology), Sojib Bin Zaman(Auckland University of Technology), Maryam Zamanian(Auckland University of Technology), Ramin Zand(Auckland University of Technology), Alireza Zandifar(Auckland University of Technology), Михаил Сергеевич Застрожин(Auckland University of Technology), Anasthasia Zastrozhina(Auckland University of Technology), Yunquan Zhang(Auckland University of Technology), Zhi-Jiang Zhang(Auckland University of Technology), Chenwen Zhong(Auckland University of Technology), Yves Miel H Zuñiga(Auckland University of Technology), Christopher J L Murray(Auckland University of Technology)
Cited by 7,480Open Access
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 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) 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 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION: The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING: Bill & Melinda Gates Foundation.
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