Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016
Journal article, 2018
BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.
Author
Gregory A. Roth
University of Washington
Valery L. Feigin
Grant Nguyen
Kelly Cercy
Catherine O. Johnson
Tahiya Alam
Priyakumari G. Parmar
Amanuel A. Abajobir
Kalkidan Hassen Abate
Foad Abd-Allah
Ayenew Negesse Abejie
Gebre Y. Abyu
Zanfina Ademi
Gina Agarwal
Muktar Beshir Ahmed
Rufus Olusola Akinyemi
Rajaa Al-Raddadi
Leopold N. Aminde
Catherine Amlie-Lefond
Hossein Ansari
Hamid Asayesh
Solomon Weldegebreal Asgedom
Tesfay M. Atey
Henok Tadesse Ayele
Maciej Banach
Amitava Banerjee
Aleksandra Barac
Suzanne L. Barker-Collo
Till Bärnighausen
Lars Barregård
Sanjay Basu
Neeraj Bedi
Masoud Behzadifar
Yannick Béjot
Derrick A. Bennett
Isabela M. Bensenor
Derbew Fikadu Berhe
Dube J. Boneya
Michael Brainin
Ismael Ricardo Campos-Nonato
Valeria Caso
Carlos A. Castañeda-Orjuela
Jacqueline Castillo Rivas
Ferrán Catalá-López
Hanne Christensen
Michael H. Criqui
Albertino Damasceno
Lalit Dandona
Rakhi Dandona
Kairat Davletov
Barbora de Courten
Gabrielle Aline Deveber
Klara Dokova
Dumessa Edessa
Matthias Endres
Emerito Jose Aquino Faraon
Maryam S. Farvid
Florian Fischer
Kyle Foreman
Mohammad H. Forouzanfar
Seana Gall
Tsegaye T. Gebrehiwot
Johanna M. Geleijnse
Richard F Gillum
Maurice Giroud
Alessandra Carvalho Goulart
Rahul Gupta
Rajeev Gupta
Vladimir Hachinski
Randah Ribhi Hamadeh
Graeme J. Hankey
Habtamu A. Hareri
Rasmus Havmoeller
Simon I. Hay
Mohamed I. Hegazy
Desalegn Tsegaw Hibstu
Spencer L. James
Panniyammakal Jeemon
Denny John
Jost B. Jonas
Jacek Józwiak
Rizwan Kalani
Amit Kandel
Amir Kasaeian
Andre Pascal Kengne
Yousef Saleh Khader
Abdur R. Khan
Young-Ho Khang
Jagdish Khubchandani
Daniel Kim
Yun J. Kim
Mika Kivimaki
Yoshihiro Kokubo
Dhaval Kolte
Jacek A. Kopec
Soewarta Kosen
Michael Kravchenko
Rita Krishnamurthi
G. Anil Kumar
Alessandra Lafranconi
Pablo M. Lavados
Yirga Legesse
Yongmei Li
Xiaofeng Liang
Warren D. Lo
Stefan Lorkowski
Paulo A. Lotufo
Clement T. Loy
Mark T. Mackay
Hassan Magdy Abd El Razek
Mahdi Mahdavi
Azeem Majeed
Reza Malekzadeh
Deborah Carvalho Malta
Abdullah A. Mamun
Lorenzo G. Mantovani
Sheila Cristina Ouriques Martins
Kedar K. Mate
Mohsen Mazidi
Chalmers, Biology and Biological Engineering, Food and Nutrition Science
Suresh Mehata
Toni Meier
Yohannes A Melaku
Walter Mendoza
George A. Mensah
Atte Meretoja
Haftay B. Mezgebe
Tomasz Miazgowski
Ted R. Miller
Norlinah M. Ibrahim
Shafiu Mohammed
Ali H. Mokdad
Mahmood Moosazadeh
Andrew E. Moran
Kamarul Imran Musa
Ruxandra Irina Negoi
Minh Nguyen
Quyen L. Nguyen
Trang Huyen Nguyen
Tung Thanh Tran
Thanh T. Nguyen
Dina Nur Anggraini Ningrum
Bo Norrving
Jean Jacques N. Noubiap
Martin J. O'Donnell
Andrew Toyin Olagunju
Oyere K. Onuma
Mayowa Ojo Owolabi
Mahboubeh Parsaeian
George C. Patton
Michael A. Piradov
Martin Pletcher
Farshad Pourmalek
V. Prakash
Mostafa Qorbani
Mahfuzar Rahman
Muhammad Aziz Rahman
Rajesh K. Rai
Annemarei Ranta
David Rawaf
Salman Rawaf
Andre M.N. Renzaho
Stephen R. Robinson
Ramesh Sahathevan
Amirhossein Sahebkar
Joshua A. Salomon
Paola Santalucia
Itamar S. Santos
Benn Sartorius
Aletta E. Schutte
Sadaf G. Sepanlou
Azadeh Shafieesabet
Masood Ali Shaikh
Morteza Shamsizadeh
Kevin N. Sheth
Mekonnen Sisay
Min-Jeong Shin
Ivy Shiue
Diego Augusto Santos Silva
Eugene Sobngwi
Michael Soljak
Reed J.D. Sorensen
Luciano A. Sposato
Saverio Stranges
Rizwan A. Suliankatchi
Rafael Tabarés-Seisdedos
David Tanne
Cuong Tat Nguyen
J.S. Thakur
Amanda G. Thrift
David L. Tirschwell
Roman Topor-Madry
Bach Xuan Tran
Luong T. Nguyen
Thomas Truelsen
Nikolaos Tsilimparis
Stefanos Tyrovolas
Kingsley Nnanna Ukwaja
Olalekan A. Uthman
Yuri Varakin
Tommi Vasankari
Narayanaswamy Venketasubramanian
Vasiliy V. Vlassov
Wenzhi Wang
Andrea Werdecker
Charles D.A. Wolfe
Gelin Xu
Yuichiro Yano
Naohiro Yonemoto
Chuanhua Yu
Zoubida Zaidi
Maysaa El Sayed Zaki
Maigeng Zhou
Boback Ziaeian
Ben Zipkin
Theo Vos
Mohsen Naghavi
Christopher J.L. Murray
New England Journal of Medicine
0028-4793 (ISSN) 1533-4406 (eISSN)
Vol. 379 25 2429-2437Subject Categories
Clinical Medicine
DOI
10.1056/NEJMoa1804492
PubMed
30575491