Death by stroke

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Understanding Death by Stroke: Global Insights and Risk Factors

Global Stroke Mortality and Burden

Stroke is a significant global health issue, ranking as the second leading cause of death worldwide and the third leading cause of death and disability combined, as measured by disability-adjusted life-years (DALYs) . The economic impact is substantial, with the global cost of stroke estimated at over $721 billion, representing 0.66% of the global GDP. The burden of stroke has increased dramatically from 1990 to 2019, with a 43% rise in stroke-related deaths and a 143% increase in DALYs. This burden is disproportionately higher in lower-income and lower-middle-income countries, which account for 86% of stroke deaths and 89% of DALYs.

Sudden Death from Stroke

Sudden death, defined as death occurring within 24 hours of symptom onset, is a critical concern in stroke cases. Strokes account for 10-20% of all sudden deaths. Primary intracerebral hemorrhage and subarachnoid hemorrhage are the leading causes of sudden death in stroke patients, with hypertension being a significant contributing factor. In a study of residents in Rochester, Minnesota, 88% of patients who died from primary intracerebral hemorrhage were hypertensive, and a notable portion were on long-term anticoagulant therapy.

Early Mortality and Risk Factors

Early mortality following a stroke is a major concern, with a bimodal distribution of deaths: one peak in the first week and another in the second and third weeks post-stroke. The primary causes of early death include transtentorial herniation due to hemorrhage or infarction, and complications from immobility such as pneumonia and sepsis. A study in a neurological intensive care unit identified central nervous system-related causes, such as brain herniation and central respiratory and circulatory failure, as the leading causes of death in severe stroke patients. Independent risk factors for mortality included multiple organ failure, dyslipidemia, lung infections, mechanical ventilation, hypoproteinemia, hypertension, and hospital-acquired pneumonia.

Long-Term Mortality and Recurrence

Long-term survival after a stroke remains challenging, with significant risks of recurrent stroke and mortality. In a study of Chinese adults, the 28-day mortality rate was 3% for ischemic stroke, 47% for intracerebral hemorrhage, and 19% for subarachnoid hemorrhage. Five years post-stroke, 41% of survivors experienced a recurrent stroke, and the mortality rate was 17%. The excess mortality in stroke patients is primarily due to cardiovascular diseases but also includes cancer, accidents, and other diseases.

Decline in Stroke Mortality

Despite the high burden, stroke mortality has been declining, particularly in high-income countries. This decline is attributed to improved prevention, acute treatment, and neurorehabilitation . Effective control of hypertension, hyperlipidemia, and smoking cessation have significantly contributed to this reduction . However, disparities in stroke mortality persist across different racial, ethnic, and geographic groups, and the burden of stroke disability remains high.

Conclusion

Stroke continues to be a leading cause of death and disability worldwide, with significant economic and social impacts. While advancements in prevention and treatment have led to a decline in stroke mortality in high-income countries, the burden remains high in lower-income regions. Understanding the risk factors and causes of death in stroke patients is crucial for developing targeted interventions to improve survival rates and reduce the global burden of stroke.