Global Burden of Stroke
- Each year 16 million people experience a stroke and 5.7 million die from it.1 87% of global stroke mortality occurs in low- and middle-income countries.1 Unless there are population-wide interventions, by 2030 there will be 23 million strokes and 7.8 million deaths each year.1
- Over the next two decades stroke mortality will triple in Latin America, the Middle East, and sub-Saharan Africa.2
- Globally, stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause in people aged 15 to 59 years of age.3 Stroke is uncommon in people under 40 years of age.3 Stroke is the third most common cause of death in developed countries, behind coronary artery disease (CAD) and cancer.3
- In many developed countries the incidence of stroke is declining but the actual number is increasing because of ageing populations.3
Table 130A. Stroke and Heart Disease Mortality and Disability-Adjusted Life Years Lost Per 100,000 in Selected Countries (2011)
|Country||Stroke mortality rate ( as % of total mortality rate )||Heart disease mortality rate( as % of total mortality rate )||Stroke DALY||Heart disease DALY|
|Russian Federation||228 (19%)||322 (27%)||1776||3051|
|China||157 (20%||63 (8%)||1072||800|
|Maldives||207 (16%)||66 (5%)||1346||475|
|Japan||42 (12%)||32 (9%)||425||274|
|Fiji||147 (15%)||159 (15%)||1536||1882|
|Sri Lanka||87 (7%)||101 (8%)||586||860|
|France||28 (6%)||38 (8%)||242||279|
|Philippines||64 (7%)||119 (12%)||636||1194|
|India||108 (9%)||208 (17%)||837||1931|
|Pakistan||118 (10%)||221 (18%)||832||1845|
|Bangladesh||11 (9%)||211 (17%)||864||1894|
|Bhutan||117 (10%)||221 (19%)||856||1920|
|Canada||26 (6%)||74 (17%)||211||495|
|UK||46 (9%)||90 (18%)||348||674|
|Singapore||46 (10%)||90 (20%)||283||648|
|Finland||42 (9%)||108 (22%)||394||730|
|USA||30 (6%)||98 (18%)||327||715|
|Mauritius||142 (17%)||225 (27%)||1065||1935|
|Afghanistan||121 (5%)||367 (16%)||1453||4259|
- In 74 member countries of WHO (39%) stroke mortality is greater than that of CAD. The burden of stroke is substantially higher in China, Africa and South America, whereas CAD burden is higher in India, Middle East, North America, Australia and most of Europe.4(Table 130A)
- Lower national income is associated with significantly higher relative mortality and disease burden from stroke.
- When vascular risk factors are considered, hypertension, heavy alcohol use and advancing age are stronger predictors of stroke than CAD. Dyslipidemia, diabetes and smoking are more strongly linked to CAD.
- The disease burden for stroke is especially high in China, probably because of high rates of hypertension and higher case fatality rates associated with their greater incidence of hemorrhagic strokes.
- A higher burden of stroke than CAD is seen in almost all Asian countries with a notable exception of India and other South Asian countries.4
- By contrast, the high burden of CAD in India may be explained by increases in dyslipidemia and diabetes associated with rising prevalence of obesity. Thus for the two most populous countries in the world, where economic resources are limited, strategies directed towards reducing the burden of CAD by the use of medical therapy may defer.5
- The Russian Federation and virtually all countries of the former Soviet Union have exceptionally high burden of both CAD and stroke.
- Each year more than 795,000 Americans have a stroke and another 200,000 to 500,000 present with a transient ischemic attack (TIA). In the US someone suffers a stroke every 40 seconds and some one dies from a stroke every 4 minutes. 6
- African Americans have a 40% greater stroke mortality than whites, of which only 23% is explained by traditional risk factors including socioeconomic status according to REGARDS study.7
1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. Feb 2007;6(2):182-187.
2. Connor MD, Walker R, Modi G, Warlow CP. Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurol. Mar 2007;6(3):269-278.
3. Mackay J, G Mensah. Atlas of Heart Disease and Stroke.: World Health Organization.Geneva, ;2004.
4. Smith SC Jr. Reducing the global burden of ischemic heart disease and stroke: a challenge for the cardiovascular community and the United Nations. Circulation. Jul 19 2011;124(3):278-279.
5. Kim AS, Johnston SC. Global variation in the relative burden of stroke and ischemic heart disease. Circulation. Jul 19 2011;124(3):314-323.
6. American Heart Association Heart and Stroke Statistical Update2010.
7. Zweifler RM, McClure LA, Howard VJ, et al. Racial and Geographic Differences in Prevalence, Awareness, Treatment and Control of Dyslipidemia: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Neuroepidemiology. 2011;37(1):39-44.