Background: Stroke is a leading cause of death and disability in globally and particularly in low- and middle-income countries, and this burden is increasing. The burden of stroke pathological subtypes varies in terms of incidence, disability and mortality. Previous Global Burden of Diseases, Injuries, and Risk Factors Studies (GBD) reports did not provide separate global burden and trends estimates for haemorrhagic stroke by primary intracerebral haemorrhage (PICH) and subarachnoid haemorrhage (SAH). Aim: To summarise the GBD 2017 findings for the burden and 27-year trends for ischaemic stroke (IS), intracerebral haemorrhage and SAH by age, sex and country income level in 21 world regions and associated risk factors. Methods: Data on stroke incidence, prevalence, mortality and disability-adjusted life-years (DALY) lost and the burden of IS, PICH and SAH were derived from all available datasets from the GBD 2017 studies. Data were analysed in terms of absolute numbers and age-standardised rates per 100,000 (95% uncertainty interval [UI]), with estimates stratified by age, sex and economic development level by the World Bank classification. We also analysed changes in the patterns of incidence, mortality and DALYs estimates between 1990 and 2017. Results: In 2017, there were 11.9 million incident (95% UI 11.1–12.8), 104.2 million prevalent (98.6–110.2), 6.2 million fatal (6.0–6.3) cases of stroke and 132.1 million stroke-related DALYs (126.5–137.4). Although stroke incidence, prevalence, mortality and DALY rates declined from 1990 to 2017, the absolute number of people who developed new stroke, died, survived or remained disabled from stroke has almost doubled. The bulk of stroke burden (80% all incident strokes, 77% all stroke survivors, 87% of all deaths from stroke and 89 of all stroke-related DALYs) in 2017 was in low- to middle-income countries. Globally in 2017, IS constituted 65%, PICH –26% and SAH –9% of all incident strokes. Discussion: The latest GBD estimates of stroke burden in 195 countries supersede previous GBD stroke burden findings and provide most accurate data for stroke care planning and resource allocation globally, regionally and for 195 countries. Stroke remains the second leading cause of deaths and disability worldwide. The increased stroke burden continues to exacerbate a huge pressure on people affected by stroke, their families and societies. It is imperative to develop and implement more effective primary prevention strategies to reduce stroke burden and its impact.

1.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, 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 Dec;380(9859):2095–128.
2.
Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, et al.; GBD 2016 Lifetime Risk of Stroke Collaborators. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016.
N Engl J Med
. 2018 Dec;379(25):2429–37.
3.
Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al.; GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Lancet Neurol
. 2019 May;18(5):439–58.
4.
O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al.; INTERSTROKE investigators. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study.
Lancet
. 2016 Aug;388(10046):761–75.
5.
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al.; GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Lancet
. 2018 Nov;392(10159):1736–88.
6.
Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study.
Bull World Health Organ
. 1980;58(1):113–30.
7.
Feigin VL, Krishnamurthi RV, Theadom AM, et al.; GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Lancet Neurol
. 2017 Nov;16(11):877–97.
8.
Roth GA, Johnson CO, Nguyen G, Naghavi M, Feigin VL, Murray CJ, et al. Methods for Estimating the Global Burden of Cerebrovascular Diseases.
Neuroepidemiology
. 2015;45(3):146–51.
9.
Feigin VL, Anderson CS, Rodgers A, Bennett DA. Subarachnoid haemorrhage occurrence exhibits a temporal pattern - evidence from meta-analysis.
Eur J Neurol
. 2002 Sep;9(5):511–6.
10.
Institute for Health Metrics and Evaluation. GOB 2017. GBD Compare Viz Hub [online]. Available from: https://vizhub.healthdata.org/gbd-compare/.
11.
Feigin VL, Norrving B, George MG, Foltz JL, Roth GA, Mensah GA. Prevention of stroke: a strategic global imperative.
Nat Rev Neurol
. 2016 Sep;12(9):501–12.
12.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al.; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.
Lancet
. 2014 Jan;383(9913):245–54.
13.
de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends.
J Neurol Neurosurg Psychiatry
. 2007 Dec;78(12):1365–72.
14.
Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al.; GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Lancet
. 2018 Nov;392(10159):1859–922.
15.
Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. 1971.
Milbank Q
. 2005;83(4):731–57.
16.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.
Lancet Neurol
. 2009 Apr;8(4):355–69.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.