title: The global burden of ischemic stroke: findings of the GBD 2010 study.
abstract: This study sought to summarize the findings of the GBD 2010 (Global Burden of Diseases, Injuries, and Risk Factors) study for ischemic stroke (IS) and to report the impact of tobacco smoking on IS burden in specific countries. The GBD 2010 searched multiple databases to identify relevant studies published between 1990 and 2010. The GBD 2010 analytical tools were used to calculate region-specific IS incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life years (DALY) lost, including 95% uncertainty intervals (UI). In 2010, there were approximately 11,569,000 incident IS events (63% in low- and middle-income countries [LMIC]), approximately 2,835,000 deaths from IS (57% in LMIC), and approximately 39,389,000 DALY lost due to IS (64% in LMIC). From 1990 to 2010, there was a significant increase in global IS burden in terms of absolute number of people with incident IS (37% increase), deaths from IS (21% increase), and DALY lost due to IS (18% increase). Age-standardized IS incidence, DALY lost, mortality, and mortality-to-incidence ratios in high-income countries declined by about 13% (95% UI: 6% to 18%), 34% (95% UI: 16% to 36%), and 37% (95% UI: 19% to 39%), 21% (95% UI: 10% to 27%), respectively. However, in LMIC there was a modest 6% increase in the age-standardized incidence of IS (95% UI: -7% to 18%) despite modest reductions in mortality rates, DALY lost, and mortality-to-incidence ratios. There was considerable variability among country-specific estimates within broad GBD regions. China, Russia, and India were ranked highest in both 1990 and 2010 for IS deaths attributable to tobacco consumption. Although age-standardized IS mortality rates have declined over the last 2 decades, the absolute global burden of IS is increasing, with the bulk of DALY lost in LMIC. Tobacco consumption is an important modifiable risk factor for IS, and in both 1990 and 2010, the top ranked countries for IS deaths that could be attributed to tobacco consumption were China, Russia, and India. Tobacco control policies that target both smoking initiation and smoking cessation can play an important role in the prevention of IS. In China, Russia, and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: derrick.bennett@ctsu.ox.ac.uk.
authors.forename: Derrick A
authors.initials: DA
authors.lastname: Bennett
authors.affiliation: Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Krishnamurthi
authors.affiliation: Department of Psychology, the University of Auckland, Auckland, New Zealand.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barker-Collo
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: NHS Borders, Melrose, UK; Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Myles
authors.initials: M
authors.lastname: Connor
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: Division of General Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Anderson
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Roth
authors.affiliation: Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.affiliation: MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Medical Faculty Building, Norfolk Place, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
authors.affiliation: Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand.
authors.forename: Valery L
authors.initials: VL
authors.lastname: Feigin
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality; D017281:Cost of Illness; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality