What is the mortality and morbidity associated with stroke?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Each year in the United States, approximately 795,000 people experience new or recurrent stroke. Of these, approximately 610,000 represent initial attacks, and 185,000 represent recurrent strokes. The incidence of stroke varies depending on age, gender, ethnicity, and socioeconomic status. Approximately 87% of strokes in the United States are ischemic, 10% are secondary to intracerebral hemorrhage, and another 3% may be secondary to subarachnoid hemorrhage. [1]

The global incidence of stroke has at least modest variation from nation to nation, suggesting the importance of genetics and environmental factors, such as disparities in access to healthcare for developing countries. According to the World Health Organization, 15 million people suffer stroke worldwide each year. The age-adjusted incidence of total strokes per 1000 person-years for people 55 years or older has been reported in the range of 4.2–6.5. The highest incidences have been reported in Russia, Ukraine, and Japan.

The increased survival among stroke victims places an increased demand on healthcare systems globally. [5, 31]

Stroke subtypes also vary greatly in different parts of the world. For example, the proportion of hemorrhagic strokes may be even higher in certain populations, such as in China, which was reported to be up to 39.4%, and up to 38.7% in Japan. [31, 32]

Stroke is the second leading cause of death and the third leading cause of disability in the world. In 2010, there were 16.9 million incident stroke cases, 33.0 million prevalent stroke cases, and 5.9 million deaths attributed to stroke. According to a report from the American Heart Association, approximately 87% of all strokes were ischemic strokes. Stroke accounts for approximately 9% of deaths around the world. The mortality approaches 50-100 deaths per 100,000 people per year worldwide but varies significantly regionally. Mortality is highest in many developing nations, likely due to genetic and socioeconomic factors, prevalence of modifiable risk factors, and differences in available healthcare resources for diagnosis and treatment. [33, 34, 35, 36, 37, 38]

The decline in US stroke death rates for more than 4 decades has begun to slow. According to the Centers for Disease Control and Prevention (CDC), in adults aged 35 years or older, stroke death rates declined 38% from 2000 to 2015. The annual percent change (APC) in stroke death rates changed from a 3.4% decrease per year during 2000-2003, to a 6.6% decrease per year during 2003-2006, to a 3.1% decrease per year during 2006-2013, to a 2.5% increase per year during 2013-2015. The last trend indicated a reversal from a decrease to a statistically significant increase in Hispanics (APC = 5.8%) and in persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states. During 2013-2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline had been sustained. [39, 40]

Approximately 25% of ischemic strokes are fatal within a month, nearly one third by 6 months, and 50% by 1 year. Stroke mortality is even higher for those with primary intracerebral hemorrhage and subarachnoid hemorrhage, which approach 50% mortality by one month. [5, 31]

For subarachnoid hemorrhage, the mortality is approximately 35% after the initial bleed. [41] Vasospasm is the leading cause of death in those who survive the initial hemorrhage, [42] with the peak incidence occurring 5-12 days after the aneurysm rupture. Rebleeding is also associated with a significantly increased mortality of approximately 70% in survivors of the initial bleed. [30]

Estimates of population-based studies have shown that approximately 500 per 100,000 live with the consequences of stroke with the age-adjusted prevalence for people aged 65 years or more ranging from 46.1 to 73.3 per 1000 population. It has been estimated that stroke-related disability is the sixth most common cause of reduced disability-adjusted life-years. [5]

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