People having a stroke
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Global Burden and Impact of Stroke
Stroke Incidence and Prevalence
Stroke remains a significant global health issue, being the second leading cause of death and a major cause of disability worldwide. The incidence and prevalence of stroke have shown varying trends across different regions and income levels. From 1990 to 2010, the age-standardized incidence of stroke decreased by 12% in high-income countries but increased by 12% in low- and middle-income countries. In China, the age-standardized prevalence and incidence rates were 1114.8 and 246.8 per 100,000 people, respectively, with a notable increase in stroke burden over the past 30 years, especially in rural areas. In India, the crude incidence of stroke ranged from 108 to 172 per 100,000 people per year, highlighting the need for more comprehensive data to guide stroke policy and services.
Mortality and Disability
Stroke mortality rates have decreased significantly in both high-income and low- and middle-income countries. However, the absolute number of stroke-related deaths and disability-adjusted life years (DALYs) lost has increased globally. In 2010, there were 5.9 million stroke-related deaths and 102 million DALYs lost, with the majority of the burden in low- and middle-income countries. In 2019, stroke remained the second-leading cause of death and the third-leading cause of death and disability combined, with 6.55 million deaths and 143 million DALYs due to stroke.
Socio-Economic Impact
The socio-economic impact of stroke is considerable, with significant media attention, patient and caregiver knowledge, service developments, and research efforts. It is estimated that there are 4.5 million deaths annually from stroke and over 9 million stroke survivors worldwide. The risk of recurrence over five years is 15-40%, and by 2023, the number of patients experiencing a first-ever stroke is expected to increase by about 30% compared to 1983. Stroke is a major cause of adult disability, with 65% of survivors being functionally independent one year after a stroke.
Regional Disparities
There are significant geographical differences in stroke burden. In China, the highest annual incidence and mortality of stroke were observed in the Northeast and Central regions, while the lowest were in the Southwest and South regions. In low- and middle-income countries, stroke incidence has more than doubled over the last four decades, while it has declined by 42% in high-income countries. The age-standardized stroke-related mortality rate is 3.6 times higher in low-income countries compared to high-income countries.
Risk Factors and Prevention
The leading risk factors for stroke include high systolic blood pressure, high body-mass index, high fasting plasma glucose, ambient particulate matter pollution, and smoking. Effective prevention strategies targeting these modifiable factors have proven effective in reducing stroke mortality, even in low-income settings. However, the management of stroke in low- and middle-income countries is challenged by inadequate rehabilitation services, lack of preventive measures, and poor understanding of unique risk factors.
Psychological Impact
Stroke can also lead to significant emotional problems, including depression and anxiety. Research indicates that even a minor stroke can result in posttraumatic stress disorder (PTSD), with patients experiencing re-experiencing the event, numbness, and nervousness. The fear of falling and the consequences of falls, such as reduced mobility and activity, further impact the quality of life and independence of stroke survivors.
Conclusion
The global burden of stroke is substantial and increasing, particularly in low- and middle-income countries. While age-standardized rates of stroke incidence and mortality have decreased, the absolute number of strokes, stroke survivors, and related deaths continue to rise. Addressing the disparities in stroke burden and improving prevention, treatment, and rehabilitation services are crucial to mitigating the impact of stroke worldwide.
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