Global Stroke Burden on the Rise in Younger Adults

Megan Brooks

October 23, 2013

The burden of stroke is increasing worldwide, particularly among young and middle-aged adults and in low- and middle-income countries, according to new research published today.

The data show that, globally, the number of stroke cases has increased 25% among adults 20 to 64 years during the last 2 decades. Strokes in this age group now make up 31% of the total number of strokes, compared with 25% before 1990.

Worldwide, more than 83,000 people aged 20 years and younger are affected by stroke each year; an estimated 0.5% of all strokes occur in this age group.

Researchers warn that the shift in stroke burden toward younger populations is likely to continue, and the global burden of stroke may double by 2030 unless effective preventive strategies are implemented.

"The worldwide stroke burden is growing very fast and there is now an urgent need for culturally acceptable and affordable stroke prevention, management and rehabilitation strategies to be developed and implemented worldwide," Valery Feigin, MD, director of the National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand, who worked on the research, said in a statement.

The new findings are published online October 24 in 2 papers in The Lancet and The Lancet Global Health.

Stroke Burden Will Double

The international research team estimated the incidence, prevalence, and premature death and disability caused by stroke in all 21 regions of the world for 1990, 2005, and 2010 using 119 relevant studies: 58 from high-income countries and 61 from low- and middle-income countries.

They report that although the average age of people with stroke has slightly increased, most of the burden of stroke (overall illness and death) has shifted from people older than 75 years to people 74 years and younger. This group accounts for 62% of new strokes, 45% of deaths, and 72% of illness and disability. These figures are significantly greater in low- and middle-income countries, the investigators write.

While the rate (age-standardized per 100,000 population) of stroke-related deaths has declined worldwide over the last 2 decades, the actual numbers of stroke-related deaths increased to 5.9 million — a 26% increase.

In addition, the number of people having a first stroke increased significantly to 16.9 million in 2010 (up by 68%), stroke survivors to 33 million (84% increase), and associated disability and illness to 102.2 million (up by 12%).

If these trends continue, stroke deaths, survivors, and disability and illness will more than double by 2030 (to 12 million, 70 million, and 200 million, respectively), the researchers warn.

Income a Factor

In high-income countries, the data show a reduction in the age-standardized incidence of stroke (12% decrease), premature death rates (37% decrease), and illness and disability rates (36% decrease) over the last 2 decades. This probably reflects improved education, prevention, and care, including smoking cessation, control of blood pressure, acute stroke units, and diagnosis, the researchers note.

In low- and middle-income countries, the opposite is true; stroke mortality is 42% higher and is associated with more disability and illness (46% greater) than in high-income countries. This is in part due to a rise in the prevalence of risk factors involving unhealthy diet, high blood pressure, obesity, physical inactivity, and smoking in these countries.

The data also show that 61.5% of the disability and 51.7% of stroke deaths were the result of hemorrhagic stroke, despite being less common than ischemic stroke. Those most affected by hemorrhagic stroke are people younger than 75 years and those living in low-income and middle-income countries, where incidence of hemorrhagic stroke has risen by around 19%.

"Urgent preventive measures and acute stroke care should be promoted in low-income and middle-income countries, and the provision of chronic stroke care should be developed worldwide," write Maurice Giroud, Agnès Jacquin, and Yannick Béjot from the Department of Neurology, University of Burgundy, Dijon, France, in an accompanying comment.

In a Comment in The Lancet Global Health, Graeme J. Hankey, MD, from the University of Western Australia, Perth, writes that "population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco by improving education and the environment will complement high-risk strategies of identifying those at risk of haemorrhagic (and ischaemic) stroke, thus empowering these individuals to improve their lifestyle behaviours and, if necessary, lower their mean blood pressure and blood pressure variability with appropriate doses of antihypertensive drugs."

Lancet. Published online October 23, 2013.

Lancet Global Health. Published online October 23, 2013.

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