Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

Gregory A. Roth*, Valery L. Feigin, Grant Nguyen, Kelly Cercy, Catherine O. Johnson, Tahiya Alam, Priyakumari G. Parmar, Amanuel A. Abajobir, Kalkidan H. Abate, Foad Abd-Allah, Ayenew N. Abejie, Gebre Y. Abyu, Zanfina Ademi, Gina Agarwal, Muktar B. Ahmed, Rufus O. Akinyemi, Rajaa Al-Raddadi, Leopold N. Aminde, Catherine Amlie-Lefond, Hossein AnsariHamid Asayesh, Solomon W. Asgedom, Tesfay M. Atey, Henok T. Ayele, Maciej Banach, Amitava Banerjee, Aleksandra Barac, Suzanne L. Barker-Collo, Till Bärnighausen, Lars Barregard, Sanjay Basu, Neeraj Bedi, Masoud Behzadifar, Yannick Béjot, Derrick A. Bennett, Isabela M. Bensenor, Derbew F. Berhe, Dube J. Boneya, Michael Brainin, Ismael R. Campos-Nonato, Valeria Caso, Carlos A. Castañeda-Orjuela, Jacquelin C. Rivas, Ferrán Catalá-López, Hanne Christensen, Michael H. Criqui, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Barbora de Courten, Gabrielle deVeber, Kevin N. Sheth, Dumessa Edessa, Matthias Endres, Emerito J.A. Faraon, Maryam S. Farvid, Florian Fischer, Kyle Foreman, Mohammad H. Forouzanfar, Seana L. Gall, Tsegaye T. Gebrehiwot, Johanna M. Geleijnse, Richard F. Gillum, Maurice Giroud, Alessandra C. Goulart, Rahul Gupta, Rajeev Gupta, Vladimir Hachinski, Randah R. Hamadeh, Graeme J. Hankey, Habtamu A. Hareri, Rasmus Havmoeller, Simon I. Hay, Mohamed I. Hegazy, Desalegn T. Hibstu, Spencer L. James, Panniyammakal Jeemon, Denny John, Jost B. Jonas, Jacek Jóźwiak, Rizwan Kalani, Amit Kandel, Amir Kasaeian, Andre P. Kengne, Yousef S. Khader, Abdur R. Khan, Young Ho Khang, Jagdish Khubchandani, Daniel Kim, Yun J. Kim, Mika Kivimaki, Yoshihiro Kokubo, Dhaval Kolte, Jacek A. Kopec, Soewarta Kosen, Michael Kravchenko, Rita Krishnamurthi, G. Anil Kumar, Alessandra Lafranconi, Pablo M. Lavados, Yirga Legesse, Yongmei Li, Xiaofeng Liang, Warren D. Lo, Stefan Lorkowski, Paulo A. Lotufo, Clement T. Loy, Mark T. Mackay, Hassan Magdy Abd El Razek, Mahdi Mahdavi, Azeem Majeed, Reza Malekzadeh, Deborah C. Malta, Abdullah A. Mamun, Lorenzo G. Mantovani, Sheila C.O. Martins, Kedar K. Mate, Mohsen Mazidi, Suresh Mehata, Toni Meier, Yohannes A. Melaku, Walter Mendoza, George A. Mensah, Atte Meretoja, Haftay B. Mezgebe, Tomasz Miazgowski, Ted R. Miller, Norlinah M. Ibrahim, Shafiu Mohammed, Ali H. Mokdad, Mahmood Moosazadeh, Andrew E. Moran, Kamarul I. Musa, Ruxandra I. Negoi, Minh Nguyen, Quyen L. Nguyen, Trang H. Nguyen, Tung T. Tran, Thanh T. Nguyen, Dina Nur Anggraini Ningrum, Bo Norrving, Jean J. Noubiap, Martin J. O'Donnell, Andrew T. Olagunju, Oyere K. Onuma, Mayowa O. Owolabi, Mahboubeh Parsaeian, George C. Patton, Michael Piradov, Martin A. Pletcher, Farshad Pourmalek, V. Prakash, Mostafa Qorbani, Mahfuzar Rahman, Muhammad A. Rahman, Rajesh K. Rai, Annemarei Ranta, David Rawaf, Salman Rawaf, Andre M.N. Renzaho, Stephen R. Robinson, Ramesh Sahathevan, Amirhossein Sahebkar, Joshua A. Salomon, Paola Santalucia, Itamar S. Santos, Benn Sartorius, Aletta E. Schutte, Sadaf G. Sepanlou, Azadeh Shafieesabet, Masood A. Shaikh, Morteza Shamsizadeh, Kevin N. Sheth, Mekonnen Sisay, Min Jeong Shin, Ivy Shiue, Diego A.S. Silva, Eugene Sobngwi, Michael Soljak, Reed J.D. Sorensen, Luciano A. Sposato, Saverio Stranges, Rizwan A. Suliankatchi, Rafael Tabarés-Seisdedos, David Tanne, Cuong Tat Nguyen, J.S. Thakur, Amanda G. Thrift, David L. Tirschwell, Roman Topor-Madry, Bach X. Tran, Luong T. Nguyen, Thomas Truelsen, Nikolaos Tsilimparis, Stefanos Tyrovolas, Kingsley N. Ukwaja, Olalekan A. Uthman, Yuri Varakin, Naohiro Yonemoto, Narayanaswamy Venketasubramanian, Vasiliy V. Vlassov, Wenzhi Wang, Andrea Werdecker, Charles D.A. Wolfe, Gelin Xu, Yuichiro Yano, Naohiro Yonemoto, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Maigeng Zhou, Boback Ziaeian, Ben Zipkin, Theo Vos, Mohsen Naghavi, Christopher J.L. Murray

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

176 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 languageEnglish
Pages (from-to)2429-2437
Number of pages9
JournalNew England Journal of Medicine
Volume379
Issue number25
DOIs
Publication statusPublished - 20 Dec 2018

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