Stroke death
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Stroke Death: A Global Perspective
Global Burden of Stroke Mortality
Stroke as a Leading Cause of Death
Stroke is the second leading cause of death worldwide, contributing significantly to global mortality rates . Despite advancements in medical care, the absolute number of stroke-related deaths has increased over the past few decades. From 1990 to 2010, stroke-related deaths rose by 26%, with a significant portion of this burden occurring in low- and middle-income countries (LMICs). By 2019, the number of deaths from stroke had increased by 43% compared to 1990.
Regional Disparities in Stroke Mortality
The burden of stroke mortality is not evenly distributed across the globe. High-income countries have seen a significant decrease in age-standardized stroke mortality rates, while LMICs have experienced an increase in stroke incidence and mortality . In 2010, 70.9% of stroke deaths occurred in LMICs, highlighting the need for targeted interventions in these regions.
Causes and Risk Factors of Stroke Death
Sudden Death from Stroke
Sudden death, defined as death occurring within 24 hours of symptom onset, accounts for 10-20% of all sudden deaths, with primary intracerebral and subarachnoid hemorrhages being the most common causes. Hypertension is a significant risk factor, particularly in cases of primary intracerebral hemorrhage.
Early and Long-Term Mortality
Early mortality after stroke exhibits a bimodal distribution, with peaks in the first week due to transtentorial herniation and in the second and third weeks due to complications from immobility, such as pneumonia and sepsis. Long-term survival rates remain low, with a 60% mortality rate within five years of a first stroke. Cardiovascular diseases are the leading cause of death in the long term, but other factors such as cancer, accidents, and suicide also contribute.
Specific Risk Factors in Severe Stroke Cases
In severe stroke cases, central nervous system-related causes, such as brain herniation and central respiratory and circulatory failure, are the leading causes of death. Other significant risk factors include multiple organ failure, dyslipidemia, lung infections, and the use of mechanical ventilation.
Stroke Mortality in Specific Populations
Stroke in India
In India, stroke is the fourth leading cause of death, with incidence rates ranging from 108 to 172 per 100,000 people per year. The one-month case fatality rates range from 18% to 42%, indicating a high burden of stroke mortality. The need for high-quality, prospective studies to guide stroke policy and improve stroke services in India is critical.
Stroke in China
In China, the 28-day mortality rate for stroke varies significantly by stroke type, with intracerebral hemorrhage having the highest mortality rate at 47%. The five-year mortality rate for stroke survivors is also high, particularly for those with intracerebral hemorrhage. This underscores the urgent need for improved secondary prevention strategies in China.
Conclusion
Stroke remains a major global health challenge, with significant mortality rates that vary by region and income level. While high-income countries have made strides in reducing stroke mortality, LMICs continue to bear the brunt of the burden. Understanding the causes and risk factors of stroke death is crucial for developing effective prevention and treatment strategies. Addressing these disparities and improving stroke care worldwide is essential to reducing the global burden of stroke mortality.
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