Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016

Mohsen Naghavi; Christopher J L Murray; Gregory A Roth; GBD 2016 Lifetime Risk of Stroke Collaborators

doi:10.1056/nejmoa1804492

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016

Mohsen Naghavi, Christopher J L Murray, Gregory A Roth, GBD 2016 Lifetime Risk of Stroke Collaborators

Department of Clinical Medicine

270 Citations (Scopus)

Abstract

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.

Original language	English
Journal	The New England Journal of Medicine
Volume	379
Issue number	25
Pages (from-to)	2429-2437
ISSN	0028-4793
DOIs	https://doi.org/10.1056/nejmoa1804492
Publication status	Published - 20 Dec 2018

Keywords

Adult
Age Distribution
Aged
Aged, 80 and over
Cause of Death
Female
Global Burden of Disease
Global Health
Humans
Incidence
Male
Middle Aged
Risk
Sex Distribution
Socioeconomic Factors
Stroke/epidemiology

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title = "Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016",

abstract = "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.",

keywords = "Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Female, Global Burden of Disease, Global Health, Humans, Incidence, Male, Middle Aged, Risk, Sex Distribution, Socioeconomic Factors, Stroke/epidemiology",

author = "Feigin, {Valery L} and Grant Nguyen and Kelly Cercy and Johnson, {Catherine O} and Tahiya Alam and Parmar, {Priyakumari G} and Abajobir, {Amanuel A} and Abate, {Kalkidan H} and Foad Abd-Allah and Abejie, {Ayenew N} and Abyu, {Gebre Y} and Zanfina Ademi and Gina Agarwal and Ahmed, {Muktar B} and Akinyemi, {Rufus O} and Rajaa Al-Raddadi and Aminde, {Leopold N} and Catherine Amlie-Lefond and Hossein Ansari and Hamid Asayesh and Asgedom, {Solomon W} and Atey, {Tesfay M} and Ayele, {Henok T} and Maciej Banach and Amitava Banerjee and Aleksandra Barac and Barker-Collo, {Suzanne L} and Till B{\"a}rnighausen and Lars Barregard and Sanjay Basu and Neeraj Bedi and Masoud Behzadifar and Yannick B{\'e}jot and Bennett, {Derrick A} and Bensenor, {Isabela M} and Berhe, {Derbew F} and Boneya, {Dube J} and Michael Brainin and Campos-Nonato, {Ismael R} and Valeria Caso and Casta{\~n}eda-Orjuela, {Carlos A} and Rivas, {Jacquelin C} and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Hanne Christensen and Criqui, {Michael H} and {de Courten}, Barbora and Rasmus Havmoeller and Minh Nguyen and Eugene Sobngwi and Thomas Truelsen and Mohsen Naghavi and Murray, {Christopher J L} and Roth, {Gregory A} and {GBD 2016 Lifetime Risk of Stroke Collaborators}",

year = "2018",

month = dec,

day = "20",

doi = "10.1056/nejmoa1804492",

language = "English",

volume = "379",

pages = "2429--2437",

journal = "The New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachusetts Medical Society",

number = "25",

}

TY - JOUR

T1 - Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016

AU - Feigin, Valery L

AU - Nguyen, Grant

AU - Cercy, Kelly

AU - Johnson, Catherine O

AU - Alam, Tahiya

AU - Parmar, Priyakumari G

AU - Abajobir, Amanuel A

AU - Abate, Kalkidan H

AU - Abd-Allah, Foad

AU - Abejie, Ayenew N

AU - Abyu, Gebre Y

AU - Ademi, Zanfina

AU - Agarwal, Gina

AU - Ahmed, Muktar B

AU - Akinyemi, Rufus O

AU - Al-Raddadi, Rajaa

AU - Aminde, Leopold N

AU - Amlie-Lefond, Catherine

AU - Ansari, Hossein

AU - Asayesh, Hamid

AU - Asgedom, Solomon W

AU - Atey, Tesfay M

AU - Ayele, Henok T

AU - Banach, Maciej

AU - Banerjee, Amitava

AU - Barac, Aleksandra

AU - Barker-Collo, Suzanne L

AU - Bärnighausen, Till

AU - Barregard, Lars

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Behzadifar, Masoud

AU - Béjot, Yannick

AU - Bennett, Derrick A

AU - Bensenor, Isabela M

AU - Berhe, Derbew F

AU - Boneya, Dube J

AU - Brainin, Michael

AU - Campos-Nonato, Ismael R

AU - Caso, Valeria

AU - Castañeda-Orjuela, Carlos A

AU - Rivas, Jacquelin C

AU - Catalá-López, Ferrán

AU - Christensen, Hanne

AU - Criqui, Michael H

AU - de Courten, Barbora

AU - Havmoeller, Rasmus

AU - Nguyen, Minh

AU - Sobngwi, Eugene

AU - Truelsen, Thomas

AU - Naghavi, Mohsen

AU - Murray, Christopher J L

AU - Roth, Gregory A

AU - GBD 2016 Lifetime Risk of Stroke Collaborators

PY - 2018/12/20

Y1 - 2018/12/20

N2 - 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.

AB - 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.

KW - Adult

KW - Age Distribution

KW - Aged

KW - Aged, 80 and over

KW - Cause of Death

KW - Female

KW - Global Burden of Disease

KW - Global Health

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Risk

KW - Sex Distribution

KW - Socioeconomic Factors

KW - Stroke/epidemiology

U2 - 10.1056/nejmoa1804492

DO - 10.1056/nejmoa1804492

M3 - Journal article

C2 - 30575491

SN - 0028-4793

VL - 379

SP - 2429

EP - 2437

JO - The New England Journal of Medicine

JF - The New England Journal of Medicine

IS - 25

ER -

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016

Abstract

Keywords

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