Key result
Global stroke mortality fell ~2% annually since 1990, but trended upward from 2019 to 2021.
Systematic Review
Yes
Despite long-term declines in age-standardized stroke rates, the global burden of stroke remains high and showed an increasing trend between 2019 and 2021, highlighting the need for continued and targeted prevention efforts.
BACKGROUND: This study aims to perform a comprehensive analysis of stroke burden from the Global Burden of Disease 2021. METHODS: We conducted a comprehensive analysis of the burden, including prevalence, incidence, mortality, and disability-adjusted life year rates, for stroke across 204 countries and regions from 1990 to 2021 using data from the Global Burden of Disease 2021. We calculated the estimated annual percentage change (EAPC) and performed a joinpoint regression analysis to identify the trends. We also explored the association between the stroke burden and sociodemographic index. RESULTS: The age-standardized prevalence, incidence, mortality, and disability-adjusted life year rates for stroke were 1099.310, 141.553, 87.454, and 1886.196 per 100 000 persons in 2021, respectively. The general stroke burden trends declined in EAPC analysis (age-standardized prevalence: EAPC, −0.37; age-standardized incidence: EAPC, −0.99; age-standardized mortality: EAPC, −1.81; and disability-adjusted life year: EAPC, −1.76). However, we found an increasing burden of stroke in East Asia and Southern Sub-Saharan Africa (EAPC >0). The global burdens of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke showed a similar trend. The stroke, intracerebral hemorrhage, and ischemic stroke burdens were heavier in men than in women, except for that of subarachnoid hemorrhage in women. Our joinpoint regression analysis revealed that the age-standardized burden rates of stroke decreased from 1990 to 2021 (average annual percent change <0), whereas an upward trend was observed between 2019 and 2021 (average annual percent change >0). The burden of stroke was inversely proportional to the sociodemographic index ( P <0.05), except in the case of subarachnoid hemorrhage. The actual stroke burden showed an increasing trend for stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in 2021 (during the coronavirus pandemic). CONCLUSIONS: We found age-standardized rates of stroke burden declining over time, but some areas exhibited a notable increase in the prevalence, incidence, mortality, and disability-adjusted life year rates.
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He et al. (2024) conducted a systematic review in Stroke. Time period (1990-2021) and sociodemographic index was evaluated on Age-standardized prevalence, incidence, mortality, and disability-adjusted life year rates for stroke. Global age-standardized stroke mortality declined from 1990 to 2021 (estimated annual percentage change -1.81), though an upward trend was observed between 2019 and 2021.
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