Stroke and the NeurosurgeonPeer-Review ReportEpidemiology and the Global Burden of Stroke
Introduction
Stroke remains one of the most devastating of all neurological conditions. Worldwide it accounts for approximately 5.5 million deaths annually, with 44 million disability-adjusted life-years lost. As a disease of aging, the prevalence of stroke is expected to increase significantly around the world in the years ahead as the global population older than 65 years of age continues to increase by approximately 9 million people per year (30). By 2025, the global population of people older than the age of 65 years is estimated to be approximately 800 million people, of whom two-thirds are expected to live in still-developing countries, particularly in Latin America and Asia (25). With such drastic changes projected in the years ahead, we explore the surveillance challenges, burden of disease, risk factors, economic impact, and future trends associated with stroke globally.
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Methodology of Assessing the Global Burden of Stroke
To fully assess the global burden of stroke, important basic epidemiological data are required from all regions. Unfortunately, even relatively simple measures, such as mortality, are reported by less than one-third of all countries, with most available data coming from already-developed countries (30). With the projected increase in the aging population, it is becoming increasingly important to develop and maintain reliable methods of surveillance to accurately measure the incidence, burden,
Incidence and Stroke Deaths
Globally, an estimated 16 million people suffered from a first-ever stroke in the year 2005, with an estimated prevalence of 62 million stroke survivors (21). In the absence of any meaningful clinical or public health interventions, it is expected that this number will increase to an estimated 23 million first-ever strokes, with an associated 7.8 million deaths, by 2030 (21). Approximately 56 million deaths occur annually worldwide, with approximately one-quarter of these deaths attributable to
Risk Factors for Stroke Worldwide
There has to date been only one large study cataloging the impact of varying risk factors upon the global incidence of stroke. Via a standardized case-control study design that took place in 22 countries over 3 years, a total of 3000 cases, with an equal number of age- and sex-matched controls, took part in the INTERSTROKE study (18). Cases were identified as patients presenting within five days of an acute, first-time stroke; control subjects had no history of stroke. The 22 countries included
Global Access to Stroke Care
Access to stroke care and inpatient stroke units vary widely across the world, with a large proportion of such services centered in already-developed or high-income countries. However, efforts are increasingly being made in low- and middle-income countries to increase rates of intravenous tissue plasminogen activator (tPA) administration, endovascular services, and basic emergency or rehabilitation care.
Traditionally, there have been some concerns regarding the safety and efficacy of
Economic Impact of Stroke
Stroke incidence and mortality have been highly correlated with national per capita income. For instance, a recent study of 56 population-based registries worldwide demonstrated that, from 1970 to 2008, there was a 42% decrease in stroke incidence in high-income countries, whereas low- and middle-income countries experienced a 100% increase in stroke incidence (7). In addition, another recent report analyzing more than 30 years worth of data demonstrated stroke mortality significantly increased
Conclusions
Chronic diseases have increased to approximately 50% of total disease burden in low- and middle-income countries undergoing the epidemiological transition (21). As a result, the global burden of stroke has increased, with an exponential expansion of this burden projected worldwide in the decades to come, particularly within low- and middle-income countries. Without effective preventive measures to curb this trend, the economic impact of such a stark increase in stroke burden could prove to be
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.