Risk of lifetime stroke exhibits notable geographic variation

1. The 2016 Global Burden of Disease Survey data was assessed to evaluate lifetime risk of stroke in numerous countries and territories, providing global stroke risk data showing an increased global risk of stroke in 2016 compared to 1990.

2. Lifetime stroke risk was greatest among countries in East Asia, Central Europe and Eastern Europe and also varied by sex, age, and person presence in countries of varied socioeconomic development.

Evidence Rating Level: 2 (Good)           

Study Rundown: Stroke events result in significant morbidity and mortality throughout all parts of the world. It has been observed that low- and middle-income counties experience a majority of disability resulting from stroke events, and incidence of stroke appears to be increasing globally. In order to better allocate resources and make prudent health systems decision data regarding lifetime risk of stroke occurrence is needed, and previously this assessment has been performed in select few populations and regions. This study sought to utilize the 2016 Global Burden of Disease (GBD) Study to compare lifetime risks of stroke in 2016 versus previous data from 1990, and to also evaluate stroke risks in populations stratified by factors such as sex, age, and sociodemographic index (SDI) amongst other variables. Lifetime risks of stroke were evaluated in 195 countries and territories, with East Asia, Central, and Eastern Europe being at the highest risk, and many African and South American countries having lower lifetime stroke risks. Overall men and women had similar risks of lifetime stoke. Compared to 1990, the lifetime risk of stroke was greater in 2016.

This study provides a broad and region/demographic specific analysis of lifetime stoke risk, providing useful data for making actionable healthcare resource allocation decisions. Strengths of the study include analysis of multiple countries and territories, user friendly graphics, and incorporation of SDI into lifetime risk analysis. A notable limitation is a lack of a more user friendly and interactive online tool for viewing stroke risk data.

Click to read the study in NEJM

Relevant Reading: Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling

In-Depth [cross-sectional study]: This cross-sectional study utilized data gathered in the 2016 GBD Study. The GBD study assessed major disease burden of numerous conditions and diagnosis, and this project specifically looked at stroke data including rate of first stroke, cause-specific mortality, and all-cause mortality. Data from the GBD Study was also discernable for ischemic versus hemorrhagic stroke. Estimates of lifetime stroke incidence were derived from use of the DisMod-MR model, and disease modeling tool. For 2016 the lifetime risk of stoke in patients 25 years or older was 24.9% compared to 22.8% in 1990, a significant global increase in risk by 8.9% (95% confidence interval [CI], 6.2% to 11.5%). East Asia was the region with the highest lifetime stoke risk at 38.8% (95% CI, 37.0% to 40.6%), and Eastern sub-Saharan Africa was the region with the lowest lifetime stroke risk at 11.8% (95% CI, 10.9% to 12.8%). Countries were also grouped into quintiles according to their SDI, and those in the high-middle quintile had the greatest lifetime stoke risk (31.1%; 95% CI, 29.0% to 33.0%) while those in the lowest quintile had the lowest stroke risk (13.2%; 95% CI, 12.3% to 14.2%). Globally, men and women had similar risks of stroke at 24.7% and 25.1%, respectively (overlapping 95% CI’s), though when assessed by county some individual countries had significantly difference stroke risks depending on sex. Compared to 1990, the risk of ischemic stroke was elevated by 12.7% versus 4.0% for hemorrhagic stroke. Additional data for stroke risk for specific countries and evaluation of other risk factors are presented in the supplementary data.

Image: PD

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