Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Valery, L.F.; Melsew Dagne Abate,; Yohannes Habtegiorgis Abate,; Samar Abd ElHafeez,; Abd-Allah, F.; Abdelalim, A.; Abdelkader, A.; Abdelmasseh, M.; Abd-Elsalam, S.; Abdi, P.; Abdollahi, A.; Abdoun, M.; Abd-Rabu, R.; Deldar Morad Abdulah,; Abdullahi, A.; Abebe, M.; Roberto Ariel Abeldaño Zuñiga,; S Abhilash, E.; Olugbenga Olusola Abiodun,; Abiodun, O.; Rahim Abo Kasem,; Richard Gyan Aboagye,; Abouzid, M.; Lucas Guimarães Abreu,; Woldu Aberhe Abrha,; Abtahi, D.; Samir Abu Rumeileh,; Abualhasan, A.; Abualruz, H.; Abu-Gharbieh, E.; Hana, J.A.; Niveen ME Abu-Rmeileh,; Aburuz, S.; Abu-Zaid, A.; Juan Manuel Acuna,; Denberu Eshetie Adane,; Mesafint Molla Adane,; Isaac Yeboah Addo,; Rufus Adesoji Adedoyin,; Oyelola, A.A.; Adekanmbi, V.; Adhikari, K.; Qorinah Estiningtyas Sakilah Adnani,; Adra, S.; Leticia Akua Adzigbli,; Abdelrahman Yousry Afify,; Aanuoluwapo Adeyimika Afolabi,; Afrashteh, F.; Muhammad Sohail Afzal,; Afzal, S.; Aghamiri, S.; Agyemang-Duah, W.; Bright Opoku Ahinkorah,; Ahmad, A.; Muayyad, M.A.; Ahmad, S.; Ahmad, S.; Ahmad, T.; Amir Mahmoud Ahmadzade,; Ahmed, A.; Ahmed, A.; Ahmed, H.; Syed Anees Ahmed,; Ajami, M.; Aji, B.; Essona Matatom Akara,; Rufus Olusola Akinyemi,; Mohammed Ahmed Akkaif,; Ashley, E.A.; Salah Al Awaidy,; Hanadi Al Hamad,; Syed Mahfuz Al Hasan,; Mohammad Al Qadire,; Omar Al Ta'ani,; Al-Ajlouni, Y.; Samer, O.A.; Tariq, A.A.; Al-Aly, Z.; Rasmieh Mustafa Al-amer,; Wafa, A.A.; Mohammed, S.A.; Seyedeh Yasaman Alemohammad,; Al-Fatly, B.; Adel Ali Saeed Al-Gheethi,; Fadwa Naji Alhalaiqa,; Alharrasi, M.; Ali, A.; Mohammed Usman Ali,; Ali, R.; Syed Shujait Ali,; Ali, W.; Al-Ibraheem, A.; Sheikh Mohammad Alif,; Syed Mohamed Aljunid,; Almahmeed, W.; Al-Marwani, S.; Mahmoud, A.A.; Alonso, J.; Jaber, S.A.; Rajaa, M.M.A.; Alrawashdeh, A.; Mohammed, A.A.; Najim, Z.A.; Altaany, Z.; Altaf, A.; Alaa, B.A.; Altwalbeh, D.; Alvis-Guzman, N.; Alwafi, H.; Al-Wardat, M.; Yaser Mohammed Al-Worafi,; Aly, H.; Aly, S.; Mohammad Sharif Ibrahim Alyahya,; Karem, H.A.; Walid Adnan Al-Zyoud,; 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doi:10.1016/S1474-4422(24)00369-7

Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation.

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Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Melsew Dagne Abate;Yohannes Habtegiorgis Abate;Samar Abd ElHafeez;Foad Abd-Allah;Ahmed Abdelalim;Atef Abdelkader;Michael Abdelmasseh;Sherief Abd-Elsalam;Parsa Abdi;Arash Abdollahi;Meriem Abdoun;Rami Abd-Rabu;Deldar Morad Abdulah;Auwal Abdullahi;Mesfin Abebe;Roberto Ariel Abeldaño Zuñiga;E S Abhilash;Olugbenga Olusola Abiodun;Olumide Abiodun;Rahim Abo Kasem;Richard Gyan Aboagye;Mohamed Abouzid;Lucas Guimarães Abreu;Woldu Aberhe Abrha;Dariush Abtahi;Samir Abu Rumeileh;Ahmed Abualhasan;Hasan Abualruz;Eman Abu-Gharbieh;Hana J Abukhadijah;Niveen ME Abu-Rmeileh;Salahdein Aburuz;Ahmed Abu-Zaid;Juan Manuel Acuna;Denberu Eshetie Adane;Mesafint Molla Adane;Isaac Yeboah Addo;Rufus Adesoji Adedoyin;Oyelola A Adegboye;Victor Adekanmbi;Kishor Adhikari;Qorinah Estiningtyas Sakilah Adnani;Saryia Adra;Leticia Akua Adzigbli;Abdelrahman Yousry Afify;Aanuoluwapo Adeyimika Afolabi;Fatemeh Afrashteh;Muhammad Sohail Afzal;Saira Afzal;Shahin Aghamiri;Williams Agyemang-Duah;Bright Opoku Ahinkorah;Aqeel Ahmad;Muayyad M Ahmad;Sajjad Ahmad;Shahzaib Ahmad;Tauseef Ahmad;Amir Mahmoud Ahmadzade;Ali Ahmed;Ayman Ahmed;Haroon Ahmed;Syed Anees Ahmed;Marjan Ajami;Budi Aji;Essona Matatom Akara;Rufus Olusola Akinyemi;Mohammed Ahmed Akkaif;Ashley E Akrami;Salah Al Awaidy;Hanadi Al Hamad;Syed Mahfuz Al Hasan;Mohammad Al Qadire;Omar Al Ta'ani;Yazan Al-Ajlouni;Samer O Alalalmeh;Tariq A Alalwan;Ziyad Al-Aly;Rasmieh Mustafa Al-amer;Wafa A Aldhaleei;Mohammed S Aldossary;Seyedeh Yasaman Alemohammad;Bassam Al-Fatly;Adel Ali Saeed Al-Gheethi;Fadwa Naji Alhalaiqa;Maryam Alharrasi;Abid Ali;Mohammed Usman Ali;Rafat Ali;Syed Shujait Ali;Waad Ali;Akram Al-Ibraheem;Sheikh Mohammad Alif;Syed Mohamed Aljunid;Wael Almahmeed;Sabah Al-Marwani;Mahmoud A Alomari;Jordi Alonso;Jaber S Alqahtani;Rajaa M Mohammad Al-Raddadi;Ahmad Alrawashdeh;Mohammed A Alsabri;Najim Z Alshahrani;Zaid Altaany;Awais Altaf;Alaa B Al-Tammemi;Diala Altwalbeh;Nelson Alvis-Guzman;Hassan Alwafi;Mohammad Al-Wardat;Yaser Mohammed Al-Worafi;Hany Aly;Safwat Aly;Mohammad Sharif Ibrahim Alyahya;Karem H Alzoubi;Walid Adnan Al-Zyoud;Reza Amani;Prince M Amegbor;Tewodros Getnet Amera;Tarek Tawfik Amin;Alireza Amindarolzarbi;Sohrab Amiri;Hubert Amu;Dickson A Amugsi;Ganiyu Adeniyi Amusa;Robert Ancuceanu;Deanna Anderlini;Dhanalakshmi Angappan;Abhishek Anil;Mohammed Tahir Tahir Ansari;Alireza Ansari-Moghaddam;Rockson Ansong;Saeid Anvari;Saleha Anwar;Sumadi Lukman Anwar;Ekenedilichukwu Emmanuel Anyabolo;Anayochukwu Edward Anyasodor;Geminn Louis Carace Apostol;Francis Appiah;Muhammad Aqeel;Jalal Arabloo;Razman Arabzadeh Bahri;Mosab Arafat;Aleksandr Y Aravkin;Ali Ardekani;Demelash Areda;Brhane Berhe Aregawi;Getnet Mesfin Aregu;Olatunde Aremu;Hidayat Arifin;Johan Ärnlöv;Anton A Artamonov;Judie Arulappan;Umesh Raj Aryal;Zahra Aryan;Akram M Asbeutah;Mulusew A Asemahagn;Mulu Tiruneh Asemu;Mohammad Asghari-Jafarabadi;Mubarek Yesse Ashemo;Tahira Ashraf;Armin Aslani;Haftu Asmerom Asmerom;Thomas Astell-Burt;Seyyed Shamsadin Athari;Prince Atorkey;Maha Moh'd Wahbi Atout;Alok Atreya;Avinash Aujayeb;Marcel Ausloos;Abolfazl Avan;Hamzeh Awad;Adedapo Wasiu Awotidebe;Lemessa Assefa A Ayana;Setognal Birara Aychiluhm;Amdehiwot A Aynalem;Zewdu Bishaw Aynalem;Sina Azadnajafabad;Hiva Azami;Shahkaar Aziz;Ahmed Y Azzam;Abraham Samuel Babu;Giridhara Rathnaiah Babu;Muhammad Badar;Ashish D Badiye;Pegah Bahrami Taghanaki;Saeed Bahramian;Ruhai Bai;Atif Amin Baig;Shankar M Bakkannavar;Abdulaziz T Bako;Ovidiu Constantin Baltatu;Kiran Bam;Maciej Banach;Morteza Banakar;Soham Bandyopadhyay;Palash Chandra Banik;Kannu Bansal;Yanping Bao;Miguel A Barboza;Mainak Bardhan;Noel C Barengo;Suzanne Lyn Barker-Collo;Till Winfried Bärnighausen;Hiba Jawdat Barqawi;Amadou Barrow;Lingkan Barua;Azadeh Bashiri;Hameed Akande Bashiru;Afisu Basiru;Mohammad-Mahdi Bastan;Sanjay Basu;Saurav Basu;Kavita Batra;Ahmet Begde;Babak Behnam;Amir Hossein Behnoush;Melesse B Y Belayneh;Michael Belingheri;Umar Muhammad Bello;Derrick A Bennett;Isabela M Bensenor;Fentaw Tadese 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Cioffi^{Membro del Collaboration Group};Rebecca M Cogen;Alyssa Columbus;Simona Costanzo;Rosa A S Couto;Michael H Criqui;Natalia Cruz-Martins;Silvia Magali Cuadra-Hernández;Alanna Gomes da Silva;Sriharsha Dadana;Omid Dadras;Xiaochen Dai;Koustuv Dalal;Lachlan L Dalli;G. Damiani^{Membro del Collaboration Group};Emanuele D'Amico;Lalit Dandona;Rakhi Dandona;Amira Hamed Darwish;Saswati Das;Mohsen Dashti;Mohadese Dashtkoohi;Mohammad Dashtkoohi;Maedeh Dastmardi;Kairat Davletov;Vanessa De la Cruz-Góngora;Sean DeAngelo;Aklilu Tamire Debele;Shayom Debopadhaya;Ivan Delgado-Enciso;Berecha Hundessa Demessa;Andreas K Demetriades;Edgar Denova-Gutiérrez;Emina Dervišević;Hardik Dineshbhai Desai;Aragaw Tesfaw Desale;Fikreab Desta;Vinoth Gnana Chellaiyan Devanbu;Devananda Devegowda;Syed Masudur Rahman Dewan;Amol S Dhane;Meghnath Dhimal;Vishal R Dhulipala;Michael J Diaz;Mengistie Diress;Milad Dodangeh;Phidelia Theresa Doegah;Sushil Dohare;Mohamed Fahmy Doheim;Klara Georgieva Dokova;Deepa Dongarwar;Mario D'Oria;Ojas Prakashbhai Doshi;Rajkumar Prakashbhai Doshi;Abdel Douiri;Robert Kokou Dowou;Ashel Chelsea Dsouza;Haneil Larson Dsouza;Viola Savy Dsouza;Bruce B Duncan;Andre Rodrigues Duraes;Arkadiusz Marian Dziedzic;Michael Ekholuenetale;Ibrahim Farahat El Bayoumy;Maysaa El Sayed Zaki;Iffat Elbarazi;Faris El-Dahiyat;Islam Y Elgendy;Muhammed Elhadi;Waseem El-Huneidi;Mohamed A Elmonem;Adel B Elmoselhi;Chadi Eltaha;Theophilus I Emeto;Christopher Imokhuede Esezobor;Negin Esfandiari;Zahra Esmaeili;Francesco Esposito;Mohammad Etoom;Natalia Fabin;Ibtihal Fadhil;Adeniyi Francis Fagbamigbe;Omotayo Francis Fagbule;Shahriar Faghani;Ayesha Fahim;Ildar Ravisovich Fakhradiyev;Luca Falzone;Mohammad Fareed;Jawad Fares;Carla Sofia e Sá Farinha;MoezAlIslam Ezzat Mahmoud Faris;Pawan Sirwan Faris;Mohsen Farjoud Kouhanjani;Andre Faro;Hossein Farrokhpour;Abidemi Omolara Fasanmi;Nelsensius Klau Fauk;Patrick Fazeli;Timur Fazylov;Alireza Feizkhah;Ginenus Fekadu;Xiaoqi Feng;Seyed-Mohammad Fereshtehnejad;Pietro Ferrara;Nuno Ferreira;Getahun Fetensa;Bikila Regassa Feyisa;Florian Fischer;Luisa S Flor;Kristen Marie Foley;Ana Catarina Fonseca;Roham Foroumadi;Behzad Foroutan;Daniela Fortuna;Matteo Foschi;Richard Charles Franklin;Ni Kadek Yuni Fridayani;Sridevi G;Peter Andras Gaal;Abhay Motiramji Gaidhane;Abduzhappar Gaipov;Yaseen Galali;Silvano Gallus;Aravind P Gandhi;Balasankar Ganesan;Danijela Gasevic;Prem Gautam;Rupesh K Gautam;Miglas Welay Gebregergis;Mesfin Gebrehiwot;Kebre Gebrekirstos Gebrekidan;Lemma Getacher;Genanew K Getahun;Molla Getie;Delaram J Ghadimi;Fataneh Ghadirian;Amir Ghaffari Jolfayi;Mansour Ghafourifard;Mohammad-Reza Ghasemi;Afsaneh Ghasemzadeh;Ramy Mohamed Ghazy;Ehsan Gholami;Zainab Gholami;Sherief Ghozy;Stefano Giannoni Luza;Jaleed Ahmed Gilani;Tiffany K Gill;Richard F Gillum;Ebisa Zerihun Gindaba;Elena V Gnedovskaya;Amit Goel;Mohamad Goldust;Mahaveer Golechha;Pouya Goleij;Davide Golinelli;Philimon N Gona;Giuseppe Gorini;Alessandra C Goulart;Barbara Niegia Garcia Goulart;Mahdi Gouravani;Michal Grivna;Giuseppe Grosso;Ashna Grover;Shi-Yang Guan;Giovanni Guarducci;Avirup Guha;Stefano Guicciardi;Snigdha Gulati;Damitha Asanga Gunawardane;Cui Guo;Zhifeng Guo;Anish Kumar Gupta;Bhawna Gupta;Mohak Gupta;Rahul Gupta;Rajat Das Gupta;Rajeev Gupta;Sapna Gupta;Farrokh Habibzadeh;Najah R Hadi;Mohammad Haghani Dogahe;Hamed Haghi-Aminjan;Dariush Haghmorad;Arvin Haj-Mirzaian;Aram Halimi;Nadia M Hamdy;Samer Hamidi;Erin B Hamilton;Asif Hanif;Nasrin Hanifi;Graeme J Hankey;Md Abdul Hannan;Zaim Anan Haq;Arief Hargono;Netanja I Harlianto;Josep Maria Haro;Eka Mishbahatul Marah Has;Ahmed I Hasaballah;Ikramul Hasan;Md Saquib Hasnain;Ikrama Hassan;Mahgol Sadat Hassan Zadeh Tabatabaei;Johannes Haubold;Rasmus J Havmoeller;Simon I Hay;Youssef Hbid;Jeffrey J Hebert;Omar E Hegazi;Mohammad Heidari;Mehdi Hemmati;Demisu Zenbaba Heyi;Kamal Hezam;Yuta Hiraike;Nguyen Quoc Hoan;Ramesh Holla;Nobuyuki Horita;Md Mahbub Hossain;Hassan Hosseinzadeh;Mehdi Hosseinzadeh;Ahmad Hosseinzadeh Adli;Mihaela Hostiuc;Sorin Hostiuc;Ben Hu;Chengxi Hu;Junjie Huang;Ayesha Humayun;Salman Hussain;Le Duc Huy;Hong-Han Huynh;Bing-Fang Hwang;Segun Emmanuel Ibitoye;Nayu Ikeda;Adalia Ikiroma;Olayinka Stephen Ilesanmi;Irena M Ilic;Milena D Ilic;Mohammad Tarique Imam;Mustapha Immurana;Leeberk Raja Inbaraj;Muhammad Iqhrammullah;Arnaud Iradukunda;Lalu Muhammad Irham;Md Rabiul Islam;Faisal Ismail;Nahlah Elkudssiah Ismail;Hiroyasu Iso;Gaetano Isola;Ramaiah Itumalla;Masao Iwagami;Chidozie Declan CD Iwu;Vinothini J;Jalil Jaafari;Louis Jacob;Abdollah Jafarzadeh;Haitham Jahrami;Akhil Jain;Nityanand Jain;Ammar Abdulrahman Jairoun;Abhishek Jaiswal;Mihajlo Jakovljevic;Reza Jalilzadeh Yengejeh;Balamurugan Janakiraman;Abubakar Ibrahim Jatau;Sathish Kumar Jayapal;Shubha Jayaram;Sun Ha Jee;Jayakumar Jeganathan;Mihretu Jegnie;Alelign Tasew Jema;Bijay Mukesh Jeswani;Angeline Jeyakumar;Anil K Jha;Ravi Prakash Jha;Zixiang Ji;Heng Jiang;Shuai Jin;Yingzhao Jin;Mohammad Jokar;Jost B Jonas;Tamas Joo;Jobinse Jose;Nitin Joseph;Charity Ehimwenma Joshua;Farahnaz Joukar;Jacek Jerzy Jozwiak;Mikk Jürisson;Ali Kabir;Md Awal Kabir;Zubair Kabir;Vidya Kadashetti;Rizwan Kalani;Sanjay Kalra;Vineet Kumar Kamal;Arun Kamireddy;Haidong Kan;Mona Kanaan;Himal Kandel;Kehinde Kazeem Kanmodi;Rami S Kantar;Neeti Kapoor;Paschalis Karakasis;Ibraheem M Karaye;André Karch;Hanie Karimi;Salah Eddin Karimi;Yeganeh Karimi;Arman Karimi Behnagh;Prabin Karki;Hengameh Kasraei;Joonas H Kauppila;Harkiran Kaur;Neda Kaydi;Gbenga A Kayode;Foad Kazemi;Sina Kazemian;Emmanuelle Kesse-Guyot;Yousef Saleh Khader;Morteza Abdullatif Khafaie;Inn Kynn Khaing;Himanshu Khajuria;Amirmohammad Khalaji;Nauman Khalid;Anees Ahmed Khalil;Asaduzzaman Khan;Fayaz Khan;M Nuruzzaman Khan;Maseer Khan;Mohammad Jobair Khan;Moien AB Khan;Yusra H Khan;Shaghayegh Khanmohammadi;Khaled Khatab;Haitham Khatatbeh;Moawiah Mohammad Khatatbeh;Sorour Khateri;Mahalaqua Nazli Khatib;Maryam Khayamzadeh;Hamid Reza Khayat Kashani;Feriha Fatima Khidri;Manoj Khokhar;Atulya Aman Khosla;Majid Khosravi;Jagdish Khubchandani;Saeid Kian;Kwanghyun Kim;Min Seo Kim;Yun Jin Kim;Ruth W Kimokoti;Adnan Kisa;Sezer Kisa;Ali-Asghar Kolahi;Kamrun Nahar Koly;Farzad Kompani;Miikka Korja;Vladimir Andreevich Korshunov;Oleksii Korzh;Soewarta Kosen;Karel Kostev;Nikhil Kothari;Ashwin Laxmikant Kotnis;Kewal Krishan;Varun Krishna;Vijay Krishnamoorthy;Bindu Krishnan;Jera Kruja;Barthelemy Kuate Defo;Burcu Kucuk Bicer;Md Abdul Kuddus;Mohammed Kuddus;Nuworza Kugbey;Mukhtar Kulimbet;Vishnutheertha Kulkarni;Akshay Kumar;Ashish Kumar;Dewesh Kumar;G Anil Kumar;Nithin Kumar;Rakesh Kumar;Senthil Kumaran D;Amartya Kundu;Satyajit Kundu;Setor K Kunutsor;Om P Kurmi;Dian Kusuma;L V Simhachalam Kutikuppala;Ambily Kuttikkattu;Ville Kytö;C.V.B. LA VECCHIA^{Membro del Collaboration Group};Ben Lacey;Chandrakant Lahariya;Dharmesh Kumar Lal;Tea Lallukka;Judit Lám;Iván Landires;Anders O Larsson;Savita Lasrado;Kaveh Latifinaibin;Paolo Lauriola;Pablo M Lavados;Basira Kankia Lawal;Long Khanh Dao Le;Nhi Huu Hanh Le;Thao Thi Thu Le;Trang Diep Thanh Le;Paul H Lee;Seung Won Lee;Wei-Chen Lee;Yo Han Lee;Ming-Chieh Li;Wei Li;Xiaopan Li;Yichong Li;Lee-Ling Lim;Stephen S Lim;John C Lin;Daniel Lindholm;Shai Linn;Gang Liu;Runben Liu;Shuke Liu;Xiaofeng Liu;Xuefeng Liu;Erand Llanaj;Chun-Han Lo;Warren David Lo;Valerie Lohner;José Francisco López-Gil;László Lorenzovici;Stefan Lorkowski;Paulo A Lotufo;Giancarlo Lucchetti;Lisha Luo;Jay B Lusk;Zheng Feei Ma;Monika Machoy;Farzan Madadizadeh;Ralph Maddison;Elham Mahmoudi;Golnaz Mahmoudvand;Omar M Makram;Elaheh Malakan Rad;Kashish Malhotra;Ahmad Azam Malik;Iram Malik;Tauqeer Hussain Mallhi;Deborah Carvalho Malta;Abdullah A Mamun;Yosef Manla;Mohammad Hadi Mansouri;Pejman Mansouri;Vahid Mansouri;Mohammad Ali Mansournia;Lorenzo Giovanni Mantovani;Emmanuel Manu;Hamid Reza Marateb;Abdoljalal Marjani;D. Martini^{Membro del Collaboration Group};Santi Martini;Miquel Martorell;Sharmeen Maryam;Roy Rillera Marzo;Awoke Masrie;Yasith Mathangasinghe;Pallab K Maulik;Mahsa Mayeli;Mohsen Mazidi;Martin McKee;Steven M McPhail;Enkeleint A Mechili;Asim Mehmood;Kamran Mehrabani-Zeinabad;Tesfahun Mekene Meto;Hadush Negash Meles;Walter Mendoza;Ritesh G Menezes;George A Mensah;Sultan Ayoub Meo;Atte Meretoja;Tuomo J Meretoja;Tomislav Mestrovic;Chamila Dinushi Kukulege Mettananda;Tomasz Miazgowski;Irmina Maria Michalek;Giuseppe Minervini;Le Huu Nhat Minh;GK Mini;Mojgan Mirghafourvand;Andreea Mirica;Erkin M Mirrakhimov;Mohammad Mirza-Aghazadeh-Attari;Manish Mishra;Sanjeev Misra;Prasanna Mithra;Ahmed Ismail Mohamed;Jama Mohamed;Nouh Saad Mohamed;Ameen Mosa Mohammad;Esmaeil Mohammadi;Saeed Mohammadi;Soheil Mohammadi;Abdollah Mohammadian-Hafshejani;Ibrahim Mohammadzadeh;Hussen Mohammed;Mustapha Mohammed;Salahuddin Mohammed;Shafiu Mohammed;Ali H Mokdad;Hossein Molavi Vardanjani;Mariam Molokhia;Shaher Momani;Lorenzo Monasta;Mohammad Ali Moni;Fateme Montazeri;AmirAli Moodi Ghalibaf;Mahmood Moosazadeh;Maryam Moradi;Yousef Moradi;Paula Moraga;Lidia Morawska;Rafael Silveira Moreira;Shane Douglas Morrison;Reza Mosaddeghi Heris;Elias Mossialos;Parsa Mousavi;Ahmed Msherghi;Sumaira Mubarik;Lorenzo Muccioli;Admir Mulita;Malaisamy Muniyandi;Kavita Munjal;Efren Murillo-Zamora;Sathish Muthu;Woojae Myung;Amin Nabavi;Ashraf Fawzy Nabhan;Ayoub Nafei;Ahamarshan Jayaraman Nagarajan;Pirouz Naghavi;Ganesh R Naik;Gurudatta Naik;Mukhammad David Naimzada;Sanjeev Nair;Tapas Sadasivan Nair;Soroush Najdaghi;Hastyar Hama Rashid Najmuldeen;Noureddin Nakhostin Ansari;Vinay Nangia;Sreenivas Narasimha Swamy;Shumaila Nargus;Delaram Narimani Davani;Bruno Ramos Nascimento;Gustavo G Nascimento;Ali Nasrollahizadeh;Amir Nasrollahizadeh;Zuhair S Natto;Javaid Nauman;Samidi Nirasha Kumari Navaratna;Biswa Prakash Nayak;Vinod C Nayak;Athare Nazri-Panjaki;Rawlance Ndejjo;Ionut Negoi;Ruxandra Irina Negoi;Seyed Aria Nejadghaderi;Chakib Nejjari;Mohammad Hadi Nematollahi;Samata Nepal;Charles Richard James Newton;Dang H Nguyen;Duc Hoang Nguyen;Hau Thi Hien Nguyen;Hien Quang Nguyen;Nhien Ngoc Y Nguyen;Phat Tuan Nguyen;Van Thanh Nguyen;Robina Khan Niazi;Yeshambel T Nigatu;Nasrin Nikravangolsefid;Dina Nur Anggraini Ningrum;Chukwudi A Nnaji;Lawrence Achilles Nnyanzi;Shuhei Nomura;Syed Toukir Ahmed Noor;Bo Norrving;Nawsherwan Nawsherwan;Jean Jacques Noubiap;Chisom Adaobi Nri-Ezedi;George Ntaios;Mpiko Ntsekhe;Fred Nugen;Mario Cesare Nurchis;Dieta Nurrika;Chimezie Igwegbe Nzoputam;Ogochukwu Janet Nzoputam;Bogdan Oancea;Kehinde O Obamiro;Ismail A Odetokun;Martin James O'Donnell;James Odhiambo Oguta;In-Hwan Oh;Tolulope R Ojo-Akosile;Hassan Okati-Aliabad;Sylvester Reuben Okeke;Akinkunmi Paul Okekunle;Lawrence Okidi;Osaretin Christabel Okonji;Morteza Oladnabi;Andrew T Olagunju;Muideen Tunbosun Olaiya;Oladotun Victor Olalusi;Tosin Abiola Olasehinde;Omotola O Olasupo;Matthew Idowu Olatubi;Arão Belitardo Oliveira;Gláucia Maria Moraes Oliveira;Abdulhakeem Abayomi Olorukooba;Isaac Iyinoluwa Olufadewa;Yinka Doris Doris Oluwafemi;Gideon Olamilekan Oluwatunase;Hany A Omar;Ahmed Omar Bali;Adrienne E O'Neil;Sok King Ong;Obinna E Onwujekwe;Abdulahi Opejin Opejin;Michal Ordak;Raffaele Ornello;Doris V Ortega-Altamirano;Alberto Ortiz;Esteban Ortiz-Prado;Wael M S Osman;Uchechukwu Levi Osuagwu;Stanislav S Otstavnov;Mayowa O Owolabi;Ifeoluwa Temitayo Oyeyemi;Ahmad Ozair;Mahesh Padukudru P A;Kevin Pacheco-Barrios;Alicia Padron-Monedero;Jagadish Rao Padubidri;Tamás Palicz;Raul Felipe Palma-Alvarez;Feng Pan;Songhomitra Panda-Jonas;Deepshikha Pande Katare;Anamika Pandey;Ashok Pandey;Seithikurippu R Pandi-Perumal;Leonidas D Panos;Ioannis Pantazopoulos;Paraskevi Papadopoulou;Shahina Pardhan;Pragyan Paramita Parija;Romil R Parikh;Nicholas Parsons;Roberto Passera;Dimitrios Patoulias;Uttam Paudel;Shrikant Pawar;Amy E Peden;Paolo Pedersini;Prince Peprah;Maria Odete Pereira;Mario F P Peres;Arokiasamy Perianayagam;Norberto Perico;S. 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Sharif-Askari;Amirhossein Sahebkar;Pragyan Monalisa Sahoo;Soumya Swaroop Sahoo;Mirza Rizwan Sajid;Afeez Abolarinwa Salami;Luciane B Salaroli;Mohamed A Saleh;Mohammed Z Y Salem;Giovanni A Salum;Sara Samadzadeh;Saad Samargandy;Yoseph Leonardo Samodra;Vijaya Paul Samuel;Abdallah M Samy;Juan Sanabria;Itamar S Santos;Milena M Santric-Milicevic;Made Ary Sarasmita;Aswini Saravanan;Yaser Sarikhani;Gargi Sachin Sarode;Sachin C Sarode;Maheswar Satpathy;Zafer Sattouf;Ganesh Kumar Saya;Md Abu Sayeed;Mehdi Sayyah;Nikolaos Scarmeas;Benedikt Michael Schaarschmidt;Markus P Schlaich;Maria Inês Schmidt;Ione Jayce Ceola Schneider;Art Schuermans;Austin E Schumacher;Aletta Elisabeth Schutte;David C Schwebel;Siddharthan Selvaraj;Parijat Sen;Sabyasachi Senapati;Subramanian Senthilkumaran;Mihretu Tagesse Sergindo;Yashendra Sethi;Allen Seylani;Mahan Shafie;Pritik A Shah;Saeed Shahabi;Ataollah Shahbandi;Samiah Shahid;Hamid R Shahsavari;Moyad Jamal Shahwan;Masood Ali Shaikh;Ali S Shalash;Muhammad Aaqib Shamim;Mehran Shams-Beyranvand;Anas Shamsi;Alfiya Shamsutdinova;Mohd Shanawaz;Mohammed Shannawaz;Medha Sharath;Amin Sharifan;Azam Sharifi;Javad Sharifi-Rad;Anupam Sharma;Manoj Sharma;Sourabh Sharma;Ujjawal Sharma;Vishal Sharma;Rahim Ali Sheikhi;Adithi Shetty;Mahabalesh Shetty;Premalatha K Shetty;Desalegn Shiferaw;Mika Shigematsu;Tariku Shimels;Min-Jeong Shin;Rahman Shiri;Aminu Shittu;Abdul-karim Olayinka Shitu;Ivy Shiue;Seyed Afshin Shorofi;Sunil Shrestha;Kerem Shuval;Yafei Si;Emmanuel Edwar Siddig;Mithun Sikdar;João Pedro Silva;Luís Manuel Lopes Rodrigues Silva;Abhinav Singh;Baljinder Singh;Garima Singh;Harmanjit Singh;Jasvinder A Singh;Kuldeep Singh;Narinder Pal Singh;Paramdeep Singh;Puneetpal Singh;Jussi O T Sipilä;Shravan Sivakumar;Valentin Yurievich Skryabin;Anna Aleksandrovna Skryabina;David A Sleet;Farrukh Sobia;Bogdan Socea;Abdullah Al Mamun Sohag;Ranjan Solanki;Shipra Solanki;Yerukneh Solomon;Yi Song;Soroush Soraneh;Reed J D Sorensen;Houman Sotoudeh;Ireneous N Soyiri;Michael 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2024

Abstract

Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6-7·8] deaths; 10·7% [9·8-11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8-171·6] DALYs; 5·6% [5·0-6·1] of all DALYs). In 2021, there were 93·8 million (89·0-99·3) prevalent and 11·9 million (10·7-13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4-67·7), intracerebral haemorrhage constituted 28·8% (28·3-28·8), and subarachnoid haemorrhage constituted 5·8% (5·7-6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4-117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7-38·1]), diet high in sugar-sweetened beverages (23·4% [12·7-35·7]), low physical activity (11·3% [1·8-34·9]), high systolic blood pressure (6·7% [2·5-11·6]), lead exposure (6·5% [4·5-11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5-10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation.

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	Settori scientifico-disciplinari dell'articolo (validi dal 09/05/2024)
	
				Settore MEDS-24/A - Statistica medica
			
	Data di pubblicazione
	
				2024
			
	Rivista in ANCE
	
				LANCET NEUROLOGY
			
	DOI
	
				https://dx.doi.org/10.1016/S1474-4422(24)00369-7
			
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1103488

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