ArticlesGlobal and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010
Introduction
Estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2010) ranked stroke as the second most common cause of death1 and the third most common cause of disability-adjusted life-years (DALYs)2 worldwide in 2010. A previous systematic review3 of population-based studies of stroke incidence from 28 countries showed that incidence is increasing in low-income and middle-income countries, by contrast with high-income countries where a 42% decrease in incidence has taken place in the past four decades. However, no comprehensive and comparable assessment of stroke incidence, prevalence, mortality, disability burden (as measured by DALYs lost), and recent epidemiologic trends has been estimated for most world regions. The GBD 2010 investigators developed statistical methods4 to address incomplete epidemiological data and provide the most complete and comparable estimates of the global burden of 291 diseases and injuries in all countries grouped into 21 world regions (appendix). We report estimates from GBD 2010 for stroke incidence, mortality, prevalence, and DALYs lost in all 21 GBD world regions in 1990, 2005, and 2010.
Section snippets
Literature search and data extraction
Details of study eligibility criteria, literature search strategy, and data extraction have been described in detail elsewhere.4, 5 In brief, we included only studies that used WHO's definition of stroke,6 that reported methods for ascertainment stroke cases, that distinguished between first-ever and recurrent stroke (only incident strokes were included in these analyses), and that reported an age-specific epidemiological parameter of interest and the population denominator (ie, stroke
Results
The appendix shows a flowchart for selection of studies. Of 16 558 potentially eligible studies undertaken in 1990–2010, we selected 119 articles for final analysis: 58 from high-income countries and 61 from low-income and middle-income countries. 59 studies reported incidence and excess mortality data, 34 reported prevalence, and 26 reported data only for excess mortality. The appendix provides a list of studies included in the analysis. Studies of a high methodological quality (quality rating
Discussion
This study is the first to report the global burden of stroke in terms of incidence, prevalence, mortality, DALYs lost, and mortality-to-incidence ratios across GBD regions and all countries in 1990, 2005, and 2010, and for all age groups of the population. Although the estimates from the GBD 2010 Study showed that ischaemic heart disease and stroke were the two greatest causes of death between 1990 and 2010,1, 8 our analysis provides a more detailed insight into the global burden of stroke in
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Members of the GBD Stroke Expert Group listed at end of paper