TY - JOUR
T1 - Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013
T2 - Data from the Global Burden of Disease 2013 Study
AU - Krishnamurthi, Rita V.
AU - Moran, Andrew E.
AU - Feigin, Valery L.
AU - Barker-Collo, Suzanne
AU - Norrving, Bo
AU - Mensah, George A.
AU - Taylor, Steve
AU - Naghavi, Mohsen
AU - Forouzanfar, Mohammed H.
AU - Nguyen, Grant
AU - Johnson, Catherine O.
AU - Vos, Theo
AU - Murray, Christopher J.L.
AU - Roth, Gregory A.
AU - GBD 2013 Stroke Panel Experts Group
AU - Bahit, Maria Cecilia
AU - Thrift, Amanda G.
AU - Meretoja, Atte
AU - Stavreski, Bill
AU - Anderson, Craig S.
AU - Pearse, Edwin
AU - Donnan, Geoffrey
AU - Hankey, Graeme
AU - Mackay, Mark T.
AU - Davis, Stephen
AU - Ademi, Zanfina
AU - Brainin, Michael
AU - Guliyev, Tural
AU - Hamadeh, Randah R.
AU - Harewood, Heather
AU - Springer, Karen
AU - Da Costa Leite, Iuri
AU - Fernandes, Jefferson Gomes
AU - Cabral, Norberto Luiz
AU - Lotufo, Paulo A.
AU - Dokova, Klara
AU - Pourmalek, Farshad
AU - deVeber, Gabrielle
AU - Sposato, Luciano A.
AU - Patrice Lindsay, M.
AU - Riccio, Patricia M.
AU - Lavados, Pablo M.
AU - Li, Bin
AU - Yu, Chuanhua
AU - Jiang, Guohong
AU - Ma, Jixiang
AU - Zhou, Maigeng
AU - Liu, Ming
AU - Zhu, Shankuan
AU - Wang, Wenzhi
AU - Liang, Xiaofeng
AU - Zhang, Yong
AU - Alcala-Cerra, Gabriel
AU - Christensen, Hanne K.
AU - Truelsen, Thomas
AU - Abd-Allah, Foad
AU - Temesgen, Awoke
AU - Sahle, Berhe Weldearegawi
AU - Abera, Semaw Ferede
AU - Melaku, Yohannes A
AU - Nand, Devina
AU - Giroud, Maurice
AU - Jonas, Jost B.
AU - Endres, Matthias
AU - Westerman, Ronny
AU - Stroumpoulis, Konstantinos
AU - Dorairaj, Prabhakaran
AU - Pandian, Jeyaraj Durai
AU - Mehndiratta, Man
AU - Roy, Nobhojit
AU - Jeemon, Panniyammakal
AU - Gupta, Rajeev
AU - Rajagopalan, Vasanthan
AU - Kosen, Soewarta
AU - Warouw, Tati Suryati
AU - Malekzadeh, Reza
AU - O’Donnell, Martin J.
AU - Tanne, David
AU - Bornstein, Natan M.
AU - Ricci, Stefano
AU - Caso, Valeria
AU - Kokubo, Yoshihiro
AU - Shinohara, Yukito
AU - Asad, Majed Masoud
AU - Bwire, Vitalis Kizito
AU - Jee, Sun Ha
AU - Khang, Young-Ho
AU - Yunjin, Kim
AU - Sahathevan, Ramesh
AU - Campos-Nonato, Ismael
AU - Gankpé, Fortuné
AU - Myint, Chaw Yin
AU - Geleijnse, Johanna M.
AU - Parmar, Priya
AU - Akinyemi, Rufus Olusola
AU - Norheim, Ole
AU - Khalifa, Shams Eldin
AU - Kravchenko, Michael
AU - Piradov, Michael
AU - Shalamov, Nicolay
AU - Vlassov, Vasiliy Victorovich
AU - Varakin, Yuri
AU - De Dieu Ngirabega, Jean
AU - Nyemazi, Jean Pierre
AU - Muhimpundu, Marie Aimee
AU - Saeedi, Mohammad
AU - Bedi, Neeraj
AU - Venketasubramanian, Narayanaswamy
AU - Kengne, Andre Pascal
AU - Rojas-Rueda, David
AU - Catalá-López, Ferrán
AU - Dharmaratne, Samath D.
AU - Havmoeller, Rasmus
AU - Atwine, Leo
AU - Banerjee, Amitava
AU - Wolfe, Charles
AU - Bennett, Derrick A.
AU - O'Callaghan, Finbar
AU - Shiue, Ivy
AU - Critchley, Julia A.
AU - Ezzati, Majid
AU - Soljak, Michael
AU - Connor, Myles D.
AU - Rothwell, Peter M.
AU - Chowdhury, Rajiv
AU - Salman, Rustam Al Shahi
AU - Whiteley, William
AU - Chen, Zhengming
AU - Colomar, Mercedes
AU - Durrani, Adnan M.
AU - Dayama, Anand
AU - Misganaw, Awoke
AU - Kissela, Brett M.
AU - Amlie-Lefond, Catherine
AU - Huang, Cheng
AU - Sumeet, Chugh
AU - Kim, Daniel
AU - Cundiff, David K.
AU - Tirschwell, David L.
AU - Kazi, Dhruv
AU - Qato, Dima
AU - Kabagambe, Edmond Kato
AU - Ding, Eric
AU - Bukhman, Gene
AU - Kwan, Gene
AU - Thurston, George D.
AU - Coresh, Josef
AU - Lefondulq, Kate
AU - Sheth, Kevin N.
AU - Corriere, Matthew A.
AU - Mainoo, Nana
AU - Beauchamp, Norman J.
AU - Sacco, Ralph L.
AU - Gillum, Richard F.
AU - Basu, Sanjay
AU - Schwartz, Stephen M.
AU - Chugh, Sumeet
AU - Fung, Teresa
AU - Byers, Tim E.
AU - Sampson, Uchechukwu K.A.
AU - Rocca, Walter A.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Recent evidence suggests that stroke is increasing as a cause of morbidity and mortality in younger adults, where it carries particular significance for working individuals. Accurate and up-to-date estimates of stroke burden are important for planning stroke prevention and management in younger adults. Objectives: This study aims to estimate prevalence, mortality and disability-adjusted life years (DALYs) and their trends for total, ischemic stroke (IS) and hemorrhagic stroke (HS) in the world for 1990-2013 in adults aged 20-64 years. Methodology: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease (GBD) 2013 methods. All available data on rates of stroke incidence, excess mortality, prevalence and death were collected. Statistical models were used along with country-level covariates to estimate country-specific stroke burden. Stroke-specific disability weights were used to compute years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. Results: In 2013, in younger adults aged 20-64 years, the global prevalence of HS was 3,725,085 cases (95% UI 3,548,098-3,871,018) and IS was 7,258,216 cases (95% UI 6,996,272-7,569,403). Globally, between 1990 and 2013, there were significant increases in absolute numbers and prevalence rates of both HS and IS for younger adults. There were 1,483,707 (95% UI 1,340,579-1,658,929) stroke deaths globally among younger adults but the number of deaths from HS (1,047,735 (95% UI 945,087-1,184,192)) was significantly higher than the number of deaths from IS (435,972 (95% UI 354,018-504,656)). There was a 20.1% (95% UI-23.6 to-10.3) decline in the number of total stroke deaths among younger adults in developed countries but a 36.7% (95% UI 26.3-48.5) increase in developing countries. Death rates for all strokes among younger adults declined significantly in developing countries from 47 (95% UI 42.6-51.7) in 1990 to 39 (95% UI 35.0-43.8) in 2013. Death rates for all strokes among younger adults also declined significantly in developed countries from 33.3 (95% UI 29.8-37.0) in 1990 to 23.5 (95% UI 21.1-26.9) in 2013. A significant decrease in HS death rates for younger adults was seen only in developed countries between 1990 and 2013 (19.8 (95% UI 16.9-22.6) and 13.7 (95% UI 12.1-15.9)) per 100,000). No significant change was detected in IS death rates among younger adults. The total DALYs from all strokes in those aged 20-64 years was 51,429,440 (95% UI 46,561,382-57,320,085). Globally, there was a 24.4% (95% UI 16.6-33.8) increase in total DALY numbers for this age group, with a 20% (95% UI 11.7-31.1) and 37.3% (95% UI 23.4-52.2) increase in HS and IS numbers, respectively. Conclusions: Between 1990 and 2013, there were significant increases in prevalent cases, total deaths and DALYs due to HS and IS in younger adults aged 20-64 years. Death and DALY rates declined in both developed and developing countries but a significant increase in absolute numbers of stroke deaths among younger adults was detected in developing countries. Most of the burden of stroke was in developing countries. In 2013, the greatest burden of stroke among younger adults was due to HS. While the trends in declining death and DALY rates in developing countries are encouraging, these regions still fall far behind those of developed regions of the world. A more aggressive approach toward primary prevention and increased access to adequate healthcare services for stroke is required to substantially narrow these disparities.
AB - Recent evidence suggests that stroke is increasing as a cause of morbidity and mortality in younger adults, where it carries particular significance for working individuals. Accurate and up-to-date estimates of stroke burden are important for planning stroke prevention and management in younger adults. Objectives: This study aims to estimate prevalence, mortality and disability-adjusted life years (DALYs) and their trends for total, ischemic stroke (IS) and hemorrhagic stroke (HS) in the world for 1990-2013 in adults aged 20-64 years. Methodology: Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease (GBD) 2013 methods. All available data on rates of stroke incidence, excess mortality, prevalence and death were collected. Statistical models were used along with country-level covariates to estimate country-specific stroke burden. Stroke-specific disability weights were used to compute years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013. Results: In 2013, in younger adults aged 20-64 years, the global prevalence of HS was 3,725,085 cases (95% UI 3,548,098-3,871,018) and IS was 7,258,216 cases (95% UI 6,996,272-7,569,403). Globally, between 1990 and 2013, there were significant increases in absolute numbers and prevalence rates of both HS and IS for younger adults. There were 1,483,707 (95% UI 1,340,579-1,658,929) stroke deaths globally among younger adults but the number of deaths from HS (1,047,735 (95% UI 945,087-1,184,192)) was significantly higher than the number of deaths from IS (435,972 (95% UI 354,018-504,656)). There was a 20.1% (95% UI-23.6 to-10.3) decline in the number of total stroke deaths among younger adults in developed countries but a 36.7% (95% UI 26.3-48.5) increase in developing countries. Death rates for all strokes among younger adults declined significantly in developing countries from 47 (95% UI 42.6-51.7) in 1990 to 39 (95% UI 35.0-43.8) in 2013. Death rates for all strokes among younger adults also declined significantly in developed countries from 33.3 (95% UI 29.8-37.0) in 1990 to 23.5 (95% UI 21.1-26.9) in 2013. A significant decrease in HS death rates for younger adults was seen only in developed countries between 1990 and 2013 (19.8 (95% UI 16.9-22.6) and 13.7 (95% UI 12.1-15.9)) per 100,000). No significant change was detected in IS death rates among younger adults. The total DALYs from all strokes in those aged 20-64 years was 51,429,440 (95% UI 46,561,382-57,320,085). Globally, there was a 24.4% (95% UI 16.6-33.8) increase in total DALY numbers for this age group, with a 20% (95% UI 11.7-31.1) and 37.3% (95% UI 23.4-52.2) increase in HS and IS numbers, respectively. Conclusions: Between 1990 and 2013, there were significant increases in prevalent cases, total deaths and DALYs due to HS and IS in younger adults aged 20-64 years. Death and DALY rates declined in both developed and developing countries but a significant increase in absolute numbers of stroke deaths among younger adults was detected in developing countries. Most of the burden of stroke was in developing countries. In 2013, the greatest burden of stroke among younger adults was due to HS. While the trends in declining death and DALY rates in developing countries are encouraging, these regions still fall far behind those of developed regions of the world. A more aggressive approach toward primary prevention and increased access to adequate healthcare services for stroke is required to substantially narrow these disparities.
KW - DALYs
KW - Deaths
KW - Global trends
KW - Hemorrhagic
KW - Ischemic
KW - Prevalence
KW - Stroke
KW - Young adult
UR - http://www.scopus.com/inward/record.url?scp=84946057305&partnerID=8YFLogxK
U2 - 10.1159/000441098
DO - 10.1159/000441098
M3 - Article
C2 - 26505983
AN - SCOPUS:84946057305
VL - 45
SP - 190
EP - 202
JO - Neuroepidemiology
JF - Neuroepidemiology
SN - 0251-5350
IS - 3
ER -