title: Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.
abstract: BACKGROUND
  The burden of ischaemic and haemorrhagic stroke varies between regions and over time. With differences in prognosis, prevalence of risk factors, and treatment strategies, knowledge of stroke pathological type is important for targeted region-specific health-care planning for stroke and could inform priorities for type-specific prevention strategies. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010.
  
  
  METHODS
  We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR) to calculate regional and country-specific estimates for ischaemic and haemorrhagic stroke incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life-years (DALYs) lost, by age group (aged <75 years, ≥ 75 years, and in total) and country income level (high-income and low-income and middle-income) for 1990, 2005, and 2010.
  
  
  RESULTS
  We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). Worldwide, the burden of ischaemic and haemorrhagic stroke increased significantly between 1990 and 2010 in terms of the absolute number of people with incident ischaemic and haemorrhagic stroke (37% and 47% increase, respectively), number of deaths (21% and 20% increase), and DALYs lost (18% and 14% increase). In the past two decades in high-income countries, incidence of ischaemic stroke reduced significantly by 13% (95% CI 6-18), mortality by 37% (19-39), DALYs lost by 34% (16-36), and mortality-to-incidence ratios by 21% (10-27). For haemorrhagic stroke, incidence reduced significantly by 19% (1-15), mortality by 38% (32-43), DALYs lost by 39% (32-44), and mortality-to-incidence ratios by 27% (19-35). By contrast, in low-income and middle-income countries, we noted a significant increase of 22% (5-30) in incidence of haemorrhagic stroke and a 6% (-7 to 18) non-significant increase in the incidence of ischaemic stroke. Mortality rates for ischaemic stroke fell by 14% (9-19), DALYs lost by 17% (-11 to 21%), and mortality-to-incidence ratios by 16% (-12 to 22). For haemorrhagic stroke in low-income and middle-income countries, mortality rates reduced by 23% (-18 to 25%), DALYs lost by 25% (-21 to 28), and mortality-to-incidence ratios by 36% (-34 to 28).
  
  
  CONCLUSIONS
  Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts.
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Krishnamurthi
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand. Electronic address: valery.feigin@aut.ac.nz.
authors.forename: Valery L
authors.initials: VL
authors.lastname: Feigin
authors.affiliation: Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
authors.affiliation: National Institutes of Health Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.affiliation: Consultant Neurologist, National Health Service Borders, Melrose, UK; Division of Clinical Neurosciences, University of Edinburgh, UK; Bute Medical School, University of St Andrews, UK; School of Public Health, University of the Witwatersrand, South Africa.
authors.forename: Myles
authors.initials: M
authors.lastname: Connor
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Derrick A
authors.initials: DA
authors.lastname: Bennett
authors.affiliation: Division of General Medicine, Columbia University Medical Center, NY, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.affiliation: Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, and Washington State Institute for Public Policy, WA, USA.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Anderson
authors.affiliation: Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Truelsen
authors.affiliation: National University of Ireland, Galway, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Division of Neurology, University Medicine Cluster, Yong Loo Lin School of Medicine, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
authors.affiliation: School of Psychology, University of Auckland, Auckland, New Zealand.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barker-Collo
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Carlene M M
authors.initials: CM
authors.lastname: Lawes
authors.affiliation: Beijing Neurosurgical Institute, Beijing, China.
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Wang
authors.affiliation: Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tachikawa, Tokyo, Japan.
authors.forename: Yukito
authors.initials: Y
authors.lastname: Shinohara
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Emma
authors.initials: E
authors.lastname: Witt
authors.affiliation: MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D017281:Cost of Illness; D006233:Persons with Disabilities; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult
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