Epidemiology

Epidemiology

Despite the fact that stroke is largely preventable, the global incidence of stroke is rising, there is still relatively low awareness of the risk factors1, and until recently, stroke has not been seen as a top healthcare priority.2,3 There is now increasing pressure on health authorities to focus more on non-communicable diseases, especially heart disease, stroke and diabetes, and introduce more effective measures to prevent stroke and optimise stroke care in line with international guidelines.4

Burden of stroke

Stroke is the second leading cause of death worldwide5 and third most common cause of disability-adjusted life-years (DALYs).6

2013

In 2013, ischaemic stroke was responsible for:

  • 67% of the 10.3 million new strokes that occurred worldwide.7
  • 71% of the approximately 25.7 million survivors of stroke.7
  • 51% of the 6.5 million deaths from stroke.7
  • 58% of the 113 million DALYs due to stroke.7

The World Health Organisation has predicted that DALYs lost to stroke will rise from 38 million in 1990 to 61 million in 2020.8

Between 1990-2013, the number of deaths from stroke decreased in high-income countries, whilst increasing in developing countries, indicating that there is a high need to optimise stroke prevention and improve stroke management in these countries.9

Global burden of stroke: mortality

Global burden of stroke: mortality

Geographical differences

There are substantial geographical differences in the burden of stroke, with low- and middle-income countries bearing the highest burden of stroke.

  • In 2013, the number of deaths from stroke was 4.85 million in low- and middle-income countries compared to 1.6 million in high-income countries.10
  • Likewise, the number of DALYs in developing countries was 91.4 million versus 21.5 million in high-income countries.10

Proportional contribution (%) of ischaemic stroke (IS) to all health conditions by year and country development

 

For more information on the angels initiative to improve the treatment of acute ischaemic stroke in low- and middle-income countries, please visit: http://www.angels-initiative.com

Gender differences

A higher global incidence of ischaemic but not haemorrhagic stroke is reported men than in women. The incidence rate in women has significantly decreased between 1990 and 2013, but in men the decrease was not significant11

The number of DALYs lost to stroke is similar in men and in women, although the DALYs lost have increased in both sexes from 1990-2013.11

Gender differences

 

Costs

Total estimated costs of stroke in Europe is 64.1 billion Euro (42.4 billion € in direct medical costs; 16.8 billion € in direct non-medical costs; and 4.9 billion € in indirect costs).12

Total estimated costs of stroke in the United States is 33.6 billion USD, with approximately 17.5 billion USD in direct medical costs.13

Comparison of direct medical, and non-medical and indirect costs of stroke in Europe and the US

References 
  1. Feigin V, Forouzanfar M, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014;383:245-255.
  2. Thrift A, Cadilhac D, Thayabaranathan T, et al. Global stroke statistics. Int J Stroke 2014;9(1):6-18.
  3. Mensah G, Norrving B, Feigin V. The global burden of stroke. Neuroepidemiology 2015;45:143-145.
  4. Norrving B, Davis SM, Feigin VL, Mensah GA, Sacco RL, Varghese C: Stroke prevention worldwide – what could make it work? Neuroepidemiology 2015;45:215-220.
  5. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-2128.
  6. Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life-years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197-2223.
  7. Feigin VL, Mensah GA, Norrving B, Murray CJL, Roth GA, et al: Atlas of the global burden of stroke (1990–2013): the GBD 2013 study. Neuroepidemiology 2015;45:230-236.
  8. Mensah GA, Sacco RL, Vickrey BG, et al: From data to action: neuroepidemiology informs implementation research for global stroke prevention and treatment. Neuroepidemiology 2015;45:221-229.
  9. Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, et al: Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 study. Neuroepidemiology 2015;45:161-176.
  10. WHO. CVD Atlas 2004.
  11. Barker-Collo S, Bennett DA, Krishnamurthi RV, et al: Sex Differences in stroke incidence, prevalence, mortality and disability-adjusted life years: results from the global burden of disease study 2013. Neuroepidemiology 2015; 45:203-214.
  12. Gustavsson A, Svensson M, Jacobi F, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:718-779.
  13. Mozaffarian D, Benjamin E, Go A, et al. Heart disease and stroke statistics – 2015 update: A report from the American Heart Association. Circulation 2015;131:e29-e322.