Stroke and death
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These studies suggest that stroke is a leading cause of death and disability worldwide, with a significant burden in low- and middle-income countries, and various risk factors including hypertension, bereavement-related stress, and inadequate healthcare services.
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Stroke and Death: A Global Perspective
Global Burden of Stroke
Stroke Incidence and Mortality Rates
Stroke is the second leading cause of death globally and a major contributor to disability . 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. Despite a decrease in mortality rates in both high-income (37%) and low- and middle-income countries (20%), the absolute number of stroke-related deaths increased by 26% during this period. By 2019, the burden of stroke had further escalated, with a 70% increase in incident strokes and a 43% rise in stroke-related deaths since 1990.
Regional Disparities
The majority of the global stroke burden is concentrated in low- and middle-income countries, which account for 86% of stroke deaths and 89% of disability-adjusted life years (DALYs) lost due to stroke . These regions have seen a more than twofold increase in stroke incidence over the past four decades, while high-income countries have experienced a 42% decline. The reasons for these disparities include differences in healthcare infrastructure, availability of diagnostic tools, and prevalence of risk factors such as hypertension and diabetes.
Sudden Death from Stroke
Causes and Risk Factors
Sudden death, defined as death occurring within 24 hours of symptom onset, accounts for 10-20% of all stroke-related deaths. Primary intracerebral hemorrhage and subarachnoid hemorrhage are the leading causes of sudden death, with hypertension being a significant risk factor. In a study of stroke patients in Rochester, Minnesota, 88% of those who died from primary intracerebral hemorrhage had hypertension, and a notable proportion were on long-term anticoagulant therapy.
Immediate Mortality
The short-term prognosis after a first stroke varies by stroke type. For instance, 28-day mortality rates are significantly higher for intracerebral hemorrhage (47%) compared to ischemic stroke (3%). This highlights the critical need for rapid and accurate diagnosis to guide appropriate treatment and improve survival rates.
Long-term Outcomes and Recurrent Events
Recurrent Stroke and Mortality
The risk of recurrent stroke and mortality remains high even years after the initial event. In a study of Chinese adults, 41% of stroke survivors experienced a recurrent stroke within five years, and 17% died within the same period. The type of initial stroke influences the likelihood of recurrence; for example, 91% of recurrent strokes after an ischemic stroke were also ischemic.
Quality of Life and Disability
Stroke not only leads to high mortality but also significant long-term disability. Up to 50% of stroke survivors are left chronically disabled, impacting their quality of life and increasing the economic burden on healthcare systems. This underscores the importance of effective rehabilitation and secondary prevention strategies to mitigate the long-term impacts of stroke.
Psychological and Social Factors
Bereavement and Stroke Risk
The death of a child is an extreme life event that can increase the risk of stroke in parents. Bereaved parents have a 23% higher risk of stroke, with the risk being particularly elevated immediately after the child's death. This association is likely due to the intense stress and emotional trauma experienced during bereavement, which can exacerbate underlying cardiovascular conditions.
Conclusion
Stroke remains a leading cause of death and disability worldwide, with significant regional disparities in incidence and outcomes. While high-income countries have seen improvements in stroke prevention and treatment, low- and middle-income countries continue to bear the brunt of the global stroke burden. Addressing this public health crisis requires targeted interventions to reduce risk factors, improve diagnostic capabilities, and enhance access to acute and long-term care, particularly in resource-limited settings.
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