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      Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010

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          Summary

          Background

          The burden of ischaemic and haemorrhagic stroke varies between regions and over time. With differences in prognosis, prevalence of risk factors, and treatment strategies, knowledge of stroke pathological type is important for targeted region-specific health-care planning for stroke and could inform priorities for type-specific prevention strategies. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010.

          Methods

          We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR) to calculate regional and country-specific estimates for ischaemic and haemorrhagic stroke incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life-years (DALYs) lost, by age group (aged <75 years, ≥75 years, and in total) and country income level (high-income and low-income and middle-income) for 1990, 2005, and 2010.

          Findings

          We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). Worldwide, the burden of ischaemic and haemorrhagic stroke increased significantly between 1990 and 2010 in terms of the absolute number of people with incident ischaemic and haemorrhagic stroke (37% and 47% increase, respectively), number of deaths (21% and 20% increase), and DALYs lost (18% and 14% increase). In the past two decades in high-income countries, incidence of ischaemic stroke reduced significantly by 13% (95% CI 6–18), mortality by 37% (19–39), DALYs lost by 34% (16–36), and mortality-to-incidence ratios by 21% (10–27). For haemorrhagic stroke, incidence reduced significantly by 19% (1–15), mortality by 38% (32–43), DALYs lost by 39% (32–44), and mortality-to-incidence ratios by 27% (19–35). By contrast, in low-income and middle-income countries, we noted a significant increase of 22% (5–30) in incidence of haemorrhagic stroke and a 6% (–7 to 18) non-significant increase in the incidence of ischaemic stroke. Mortality rates for ischaemic stroke fell by 14% (9–19), DALYs lost by 17% (–11 to 21%), and mortality-to-incidence ratios by 16% (–12 to 22). For haemorrhagic stroke in low-income and middle-income countries, mortality rates reduced by 23% (–18 to 25%), DALYs lost by 25% (–21 to 28), and mortality-to-incidence ratios by 36% (–34 to 28).

          Interpretation

          Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts.

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          Most cited references24

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization.

            This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
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              GBD 2010: design, definitions, and metrics.

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                Author and article information

                Journal
                101613665
                42402
                Lancet Glob Health
                Lancet Glob Health
                The Lancet. Global health
                2214-109X
                9 September 2014
                24 October 2013
                November 2013
                01 October 2014
                : 1
                : 5
                : e259-e281
                Affiliations
                National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand (R V Krishnamurthi PhD, Prof V L Feigin MD, E Witt MSc); Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA (Prof M H Forouzanfar MD, Prof M Naghavi MD, Prof C Murray MD); National Institutes of Health Heart, Lung, and Blood Institute, Bethesda, MD, USA (G A Mensah, MD); Consultant Neurologist, National Health Service Borders, Melrose, UK (M Connor MBBCh); Division of Clinical Neurosciences, University of Edinburgh, UK (M Connor MBBCh); Bute Medical School, University of St Andrews, UK (M Connor); School of Public Health, University of the Witwatersrand, South Africa (M Connor); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK (D A Bennett PhD); Division of General Medicine, Columbia University Medical Center, NY, USA (Prof A E Moran MD); Miller School of Medicine, University of Miami, Miami, FL, USA (Prof R L Sacco MD); Department of Epidemiology, School of Public Health, University of Washington, and Washington State Institute for Public Policy, WA, USA (L M Anderson PhD); Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark (T Truelsen MD); MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (Prof M Ezzati PhD); National University of Ireland, Galway, Ireland (Prof M O’Donnell PhD); Division of Neurology, University Medicine Cluster, Yong Loo Lin School of Medicine, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (N Venketasubramanian MBBS); School of Psychology (Prof S Barker-Collo PhD) and National Institute for Health Innovation (C M M Lawes MBChB), University of Auckland, Auckland, New Zealand; Beijing Neurosurgical Institute, Beijing, China (W Wang PhD); and Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tachikawa, Tokyo, Japan (Y Shinohara, MD)
                Author notes
                Correspondence to: Prof Valery L Feigin, National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupation Studies, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology University, Auckland 1142, New Zealand valery.feigin@ 123456aut.ac.nz
                [*]

                Members of the GBD Stroke Expert Group listed at end of paper

                Article
                NIHMS625987
                10.1016/S2214-109X(13)70089-5
                4181351
                25104492
                2367e5b6-82c0-424f-8f55-0161c47842b3
                © Copyright © Krishnamurthi et al.

                Open Access article distributed under the terms of CC BY-NC-ND

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