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Stroke burden set to double by 2030

Nearly a third of all strokes globally now occur in people of working age

Louise Prime

Thursday, 24 October 2013

The global burden of stroke is climbing steeply and could more than double by 2030, the latest data suggest. Authors of a report published today in The Lancet also say that over the past two decades there has been a large increase in the proportion of stroke cases in the under-65s.

Researchers for the Global and Regional Burden of Stroke 1990-2010 examined data from all 21 regions of the world for 1990, 2005 and 2010 to estimate the global incidence, prevalence, mortality, mortality-to-incidence ratio and morbidity caused by stroke overall – and by ischaemic and haemorrhagic stroke – as well as breaking it down by region and by country.

They report a significant 25% increase in strokes in people aged 20-64 years over the past 20 years. Overall, almost a third (31%) of all incident strokes in 2010 occurred in this age group, and one in 200 (0.5%) cases were in those of 20 or younger; the proportion of stroke in children and young and middle-aged adults was smaller in high-income countries, and larger in low- and middle-income countries. The researchers also looked at the burden of disability, illness and premature death caused by stroke, and projected that this could more than double by 2030.

Another major study by the same authors also published today, in The Lancet Global Health, found that although haemorrhagic strokes – caused mainly by hypertension and unhealthy lifestyles – are only half as common as ischaemic strokes, globally they account for a disproportionate amount of death and disability (51.7% and 61.5% respectively). The under-75s and those living in low- and middle-income countries were most affected; in these regions, the incidence of haemorrhagic stroke rose by about 19%.

However, the age-standardised incidence of stroke in high-income countries fell by 12% over the past two decades, as did the rate of premature death (by 37%) and disability (by 36%), which the study authors say is probably a result of better education, prevention and care (smoking cessation, hypertension treatment and availability of acute stroke units) and diagnosis.

They conclude: “Although stroke mortality rates and mortality-to-incidence ratios have decreased in the past two decades, the global burden of stroke in terms of the absolute number of people affected every year, stroke survivors, related deaths, and DALYs [disability-adjusted life-years] lost are great and increasing, with most of the burden in low-income and middle-income countries. If these trends in stroke incidence, mortality, and DALYs continue, by 2030 there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally.”

The author of an accompanying comment in The Lancet Global Health said that preventing haemorrhagic stroke, especially in the under-75s and in low- and middle-income countries, must be a key priority. He said: “Population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco by improving education and the environment will complement high-risk strategies of identifying those at risk of haemorrhagic (and ischaemic) stroke, thus empowering these individuals to improve their lifestyle behaviours and, if necessary, lower their mean blood pressure and blood pressure variability with appropriate doses of antihypertensive drugs.”

doi:10.1016/S0140-6736(13)61953-4
doi:10.1016/S0140-6736(13)61953-4
doi:10.1016/S2214-109X(13)70095-0

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