Atlas of the Global Burden of Stroke (1990-2013): The GBD 2013 StudyFeigin V.L.a · Mensah G.A.d · Norrving B.b · Murray C.J.L.c · Roth G.A.c · GBD 2013 Stroke Panel Experts Group
aFAAN, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand; bDepartment of Clinical Sciences, Neurology, Lund University, Lund, Sweden; cInstitute for Health Metrics and Evaluation and the Division of Cardiology, School of Medicine, University of Washington, Seattle, Wash., dCenter for Translation Research and Implementation Science and Division of Cardiovascular Sciences; National Heart, Lung, and Blood Institute; National Institutes of Health, Bethesda, Md., USA
Professor Valery L. Feigin, MD, MSc, PhD, FAAN
NISAN, AUT University, AUT North Shore Campus, AA254
90 Akoranga Dr, Northcote 0627
Auckland 1142 (New Zealand)
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Background: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. Objectives: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. Methodology: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality (through April 2014) and stroke incidence, prevalence, case fatality and severity through 2013. Death was estimated using an ensemble modeling approach. A new software package, DisMod-MR 2.0, was used as part of a custom modeling process to estimate YLDs. All rates were age-standardized to new GBD estimates of global population. All estimates have been computed with 95% uncertainty intervals. Results: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across all countries in the world over the same time period, suggesting that the global stroke burden continues to increase. There were significant geographical (country and regional) differences in stroke burden in the world, with the majority of the burden borne by low- and middle-income countries. Conclusions: Global burden of stroke has continued to increase in spite of dramatic declines in age-standardized incidence, prevalence, mortality rates and disability. Population growth and aging have played an important role in the observed increase in stroke burden.
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