Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

Global Burden of Disease Stroke Expert Group

Research output: Contribution to journalArticleResearchpeer-review

44 Citations (Scopus)

Abstract

BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

Original languageEnglish
Pages (from-to)2429-2437
Number of pages9
JournalNew England Journal of Medicine
Volume379
Issue number25
DOIs
Publication statusPublished - 20 Dec 2018

Cite this

Global Burden of Disease Stroke Expert Group. / Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. In: New England Journal of Medicine. 2018 ; Vol. 379, No. 25. pp. 2429-2437.
@article{d74bbc2b6008457d91eb8a81c26e2aa6,
title = "Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016",
abstract = "BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9{\%} (95{\%} uncertainty interval, 23.5 to 26.2); the risk among men was 24.7{\%} (95{\%} uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1{\%} (95{\%} uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3{\%}, and the risk of hemorrhagic stroke was 8.2{\%}. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5{\%}, 31.1{\%} (highest risk), and 13.2{\%} (lowest risk), respectively; the 95{\%} uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8{\%}), Central Europe (31.7{\%}), and Eastern Europe (31.6{\%}), and the lowest risk was in eastern sub-Saharan Africa (11.8{\%}). The mean global lifetime risk of stroke increased from 22.8{\%} in 1990 to 24.9{\%} in 2016, a relative increase of 8.9{\%} (95{\%} uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25{\%} among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.",
author = "Roth, {Gregory A.} and Feigin, {Valery L.} and Grant Nguyen and Kelly Cercy and Johnson, {Catherine O.} and Tahiya Alam and Parmar, {Priyakumari G.} and Abajobir, {Amanuel A.} and Abate, {Kalkidan H.} and Foad Abd-Allah and Abejie, {Ayenew N.} and Abyu, {Gebre Y.} and Zanfina Ademi and Gina Agarwal and Ahmed, {Muktar B.} and Akinyemi, {Rufus O.} and Rajaa Al-Raddadi and Aminde, {Leopold N.} and Catherine Amlie-Lefond and Hossein Ansari and Hamid Asayesh and Asgedom, {Solomon W.} and Atey, {Tesfay M.} and Ayele, {Henok T.} and Maciej Banach and Amitava Banerjee and Aleksandra Barac and Barker-Collo, {Suzanne L.} and Till B{\"a}rnighausen and Lars Barregard and Sanjay Basu and Neeraj Bedi and Masoud Behzadifar and Yannick B{\'e}jot and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Berhe, {Derbew F.} and Boneya, {Dube J.} and Michael Brainin and Campos-Nonato, {Ismael R.} and Valeria Caso and Casta{\~n}eda-Orjuela, {Carlos A.} and Rivas, {Jacquelin C.} and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Hanne Christensen and Criqui, {Michael H.} and Albertino Damasceno and Lalit Dandona and Rakhi Dandona and Kairat Davletov and {de Courten}, Barbora and Gabrielle deVeber and Klara Dokova and Dumessa Edessa and Matthias Endres and Faraon, {Emerito J.A.} and Farvid, {Maryam S.} and Florian Fischer and Kyle Foreman and Forouzanfar, {Mohammad H.} and Gall, {Seana L.} and Gebrehiwot, {Tsegaye T.} and Geleijnse, {Johanna M.} and Gillum, {Richard F.} and Maurice Giroud and Goulart, {Alessandra C.} and Rahul Gupta and Rajeev Gupta and Vladimir Hachinski and Hamadeh, {Randah R.} and Hankey, {Graeme J.} and Hareri, {Habtamu A.} and Rasmus Havmoeller and Hay, {Simon I.} and Hegazy, {Mohamed I.} and Hibstu, {Desalegn T.} and James, {Spencer L.} and Panniyammakal Jeemon and Denny John and Jonas, {Jost B.} and Jacek J{\'o}źwiak and Rizwan Kalani and Amit Kandel and Amir Kasaeian and Kengne, {Andre P.} and Khader, {Yousef S.} and Khan, {Abdur R.} and Khang, {Young Ho} and Jagdish Khubchandani and Daniel Kim and Kim, {Yun J.} and Mika Kivimaki and Yoshihiro Kokubo and Dhaval Kolte and Kopec, {Jacek A.} and Soewarta Kosen and Michael Kravchenko and Rita Krishnamurthi and {Anil Kumar}, G. and Alessandra Lafranconi and Lavados, {Pablo M.} and Yirga Legesse and Yongmei Li and Xiaofeng Liang and Lo, {Warren D.} and Stefan Lorkowski and Lotufo, {Paulo A.} and Loy, {Clement T.} and Mackay, {Mark T.} and {Abd El Razek}, {Hassan Magdy} and Mahdi Mahdavi and Azeem Majeed and Reza Malekzadeh and Malta, {Deborah C.} and Mamun, {Abdullah A.} and Mantovani, {Lorenzo G.} and Martins, {Sheila C.O.} and Mate, {Kedar K.} and Mohsen Mazidi and Suresh Mehata and Toni Meier and Melaku, {Yohannes A.} and Walter Mendoza and Mensah, {George A.} and Atte Meretoja and Mezgebe, {Haftay B.} and Tomasz Miazgowski and Miller, {Ted R.} and Ibrahim, {Norlinah M.} and Shafiu Mohammed and Mokdad, {Ali H.} and Mahmood Moosazadeh and Moran, {Andrew E.} and Musa, {Kamarul I.} and Negoi, {Ruxandra I.} and Minh Nguyen and Nguyen, {Quyen L.} and Nguyen, {Trang H.} and Tran, {Tung T.} and Nguyen, {Thanh T.} and {Anggraini Ningrum}, {Dina Nur} and Bo Norrving and Noubiap, {Jean J.} and O'Donnell, {Martin J.} and Olagunju, {Andrew T.} and Onuma, {Oyere K.} and Owolabi, {Mayowa O.} and Mahboubeh Parsaeian and Patton, {George C.} and Michael Piradov and Pletcher, {Martin A.} and Farshad Pourmalek and V. Prakash and Mostafa Qorbani and Mahfuzar Rahman and Rahman, {Muhammad A.} and Rai, {Rajesh K.} and Annemarei Ranta and David Rawaf and Salman Rawaf and Renzaho, {Andre M.N.} and Robinson, {Stephen R.} and Ramesh Sahathevan and Amirhossein Sahebkar and Salomon, {Joshua A.} and Paola Santalucia and Santos, {Itamar S.} and Benn Sartorius and Schutte, {Aletta E.} and Sepanlou, {Sadaf G.} and Azadeh Shafieesabet and Shaikh, {Masood A.} and Morteza Shamsizadeh and Sheth, {Kevin N.} and Mekonnen Sisay and Shin, {Min Jeong} and Ivy Shiue and Silva, {Diego A.S.} and Eugene Sobngwi and Michael Soljak and Sorensen, {Reed J.D.} and Sposato, {Luciano A.} and Saverio Stranges and Suliankatchi, {Rizwan A.} and Rafael Tabar{\'e}s-Seisdedos and David Tanne and {Tat Nguyen}, Cuong and Thakur, {J. S.} and Thrift, {Amanda G.} and Tirschwell, {David L.} and Roman Topor-Madry and Tran, {Bach X.} and Nguyen, {Luong T.} and Thomas Truelsen and Nikolaos Tsilimparis and Stefanos Tyrovolas and Ukwaja, {Kingsley N.} and Uthman, {Olalekan A.} and Yuri Varakin and Tommi Vasankari and Narayanaswamy Venketasubramanian and Vlassov, {Vasiliy V.} and Wenzhi Wang and Andrea Werdecker and Wolfe, {Charles D.A.} and Gelin Xu and Yuichiro Yano and Naohiro Yonemoto and Chuanhua Yu and Zoubida Zaidi and {El Sayed Zaki}, Maysaa and Maigeng Zhou and Boback Ziaeian and Ben Zipkin and Theo Vos and Mohsen Naghavi and Murray, {Christopher J.L.} and {Global Burden of Disease Stroke Expert Group}",
year = "2018",
month = "12",
day = "20",
doi = "10.1056/NEJMoa1804492",
language = "English",
volume = "379",
pages = "2429--2437",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachusetts Medical Society",
number = "25",

}

Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. / Global Burden of Disease Stroke Expert Group.

In: New England Journal of Medicine, Vol. 379, No. 25, 20.12.2018, p. 2429-2437.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

AU - Roth, Gregory A.

AU - Feigin, Valery L.

AU - Nguyen, Grant

AU - Cercy, Kelly

AU - Johnson, Catherine O.

AU - Alam, Tahiya

AU - Parmar, Priyakumari G.

AU - Abajobir, Amanuel A.

AU - Abate, Kalkidan H.

AU - Abd-Allah, Foad

AU - Abejie, Ayenew N.

AU - Abyu, Gebre Y.

AU - Ademi, Zanfina

AU - Agarwal, Gina

AU - Ahmed, Muktar B.

AU - Akinyemi, Rufus O.

AU - Al-Raddadi, Rajaa

AU - Aminde, Leopold N.

AU - Amlie-Lefond, Catherine

AU - Ansari, Hossein

AU - Asayesh, Hamid

AU - Asgedom, Solomon W.

AU - Atey, Tesfay M.

AU - Ayele, Henok T.

AU - Banach, Maciej

AU - Banerjee, Amitava

AU - Barac, Aleksandra

AU - Barker-Collo, Suzanne L.

AU - Bärnighausen, Till

AU - Barregard, Lars

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Behzadifar, Masoud

AU - Béjot, Yannick

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhe, Derbew F.

AU - Boneya, Dube J.

AU - Brainin, Michael

AU - Campos-Nonato, Ismael R.

AU - Caso, Valeria

AU - Castañeda-Orjuela, Carlos A.

AU - Rivas, Jacquelin C.

AU - Catalá-López, Ferrán

AU - Christensen, Hanne

AU - Criqui, Michael H.

AU - Damasceno, Albertino

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Davletov, Kairat

AU - de Courten, Barbora

AU - deVeber, Gabrielle

AU - Dokova, Klara

AU - Edessa, Dumessa

AU - Endres, Matthias

AU - Faraon, Emerito J.A.

AU - Farvid, Maryam S.

AU - Fischer, Florian

AU - Foreman, Kyle

AU - Forouzanfar, Mohammad H.

AU - Gall, Seana L.

AU - Gebrehiwot, Tsegaye T.

AU - Geleijnse, Johanna M.

AU - Gillum, Richard F.

AU - Giroud, Maurice

AU - Goulart, Alessandra C.

AU - Gupta, Rahul

AU - Gupta, Rajeev

AU - Hachinski, Vladimir

AU - Hamadeh, Randah R.

AU - Hankey, Graeme J.

AU - Hareri, Habtamu A.

AU - Havmoeller, Rasmus

AU - Hay, Simon I.

AU - Hegazy, Mohamed I.

AU - Hibstu, Desalegn T.

AU - James, Spencer L.

AU - Jeemon, Panniyammakal

AU - John, Denny

AU - Jonas, Jost B.

AU - Jóźwiak, Jacek

AU - Kalani, Rizwan

AU - Kandel, Amit

AU - Kasaeian, Amir

AU - Kengne, Andre P.

AU - Khader, Yousef S.

AU - Khan, Abdur R.

AU - Khang, Young Ho

AU - Khubchandani, Jagdish

AU - Kim, Daniel

AU - Kim, Yun J.

AU - Kivimaki, Mika

AU - Kokubo, Yoshihiro

AU - Kolte, Dhaval

AU - Kopec, Jacek A.

AU - Kosen, Soewarta

AU - Kravchenko, Michael

AU - Krishnamurthi, Rita

AU - Anil Kumar, G.

AU - Lafranconi, Alessandra

AU - Lavados, Pablo M.

AU - Legesse, Yirga

AU - Li, Yongmei

AU - Liang, Xiaofeng

AU - Lo, Warren D.

AU - Lorkowski, Stefan

AU - Lotufo, Paulo A.

AU - Loy, Clement T.

AU - Mackay, Mark T.

AU - Abd El Razek, Hassan Magdy

AU - Mahdavi, Mahdi

AU - Majeed, Azeem

AU - Malekzadeh, Reza

AU - Malta, Deborah C.

AU - Mamun, Abdullah A.

AU - Mantovani, Lorenzo G.

AU - Martins, Sheila C.O.

AU - Mate, Kedar K.

AU - Mazidi, Mohsen

AU - Mehata, Suresh

AU - Meier, Toni

AU - Melaku, Yohannes A.

AU - Mendoza, Walter

AU - Mensah, George A.

AU - Meretoja, Atte

AU - Mezgebe, Haftay B.

AU - Miazgowski, Tomasz

AU - Miller, Ted R.

AU - Ibrahim, Norlinah M.

AU - Mohammed, Shafiu

AU - Mokdad, Ali H.

AU - Moosazadeh, Mahmood

AU - Moran, Andrew E.

AU - Musa, Kamarul I.

AU - Negoi, Ruxandra I.

AU - Nguyen, Minh

AU - Nguyen, Quyen L.

AU - Nguyen, Trang H.

AU - Tran, Tung T.

AU - Nguyen, Thanh T.

AU - Anggraini Ningrum, Dina Nur

AU - Norrving, Bo

AU - Noubiap, Jean J.

AU - O'Donnell, Martin J.

AU - Olagunju, Andrew T.

AU - Onuma, Oyere K.

AU - Owolabi, Mayowa O.

AU - Parsaeian, Mahboubeh

AU - Patton, George C.

AU - Piradov, Michael

AU - Pletcher, Martin A.

AU - Pourmalek, Farshad

AU - Prakash, V.

AU - Qorbani, Mostafa

AU - Rahman, Mahfuzar

AU - Rahman, Muhammad A.

AU - Rai, Rajesh K.

AU - Ranta, Annemarei

AU - Rawaf, David

AU - Rawaf, Salman

AU - Renzaho, Andre M.N.

AU - Robinson, Stephen R.

AU - Sahathevan, Ramesh

AU - Sahebkar, Amirhossein

AU - Salomon, Joshua A.

AU - Santalucia, Paola

AU - Santos, Itamar S.

AU - Sartorius, Benn

AU - Schutte, Aletta E.

AU - Sepanlou, Sadaf G.

AU - Shafieesabet, Azadeh

AU - Shaikh, Masood A.

AU - Shamsizadeh, Morteza

AU - Sheth, Kevin N.

AU - Sisay, Mekonnen

AU - Shin, Min Jeong

AU - Shiue, Ivy

AU - Silva, Diego A.S.

AU - Sobngwi, Eugene

AU - Soljak, Michael

AU - Sorensen, Reed J.D.

AU - Sposato, Luciano A.

AU - Stranges, Saverio

AU - Suliankatchi, Rizwan A.

AU - Tabarés-Seisdedos, Rafael

AU - Tanne, David

AU - Tat Nguyen, Cuong

AU - Thakur, J. S.

AU - Thrift, Amanda G.

AU - Tirschwell, David L.

AU - Topor-Madry, Roman

AU - Tran, Bach X.

AU - Nguyen, Luong T.

AU - Truelsen, Thomas

AU - Tsilimparis, Nikolaos

AU - Tyrovolas, Stefanos

AU - Ukwaja, Kingsley N.

AU - Uthman, Olalekan A.

AU - Varakin, Yuri

AU - Vasankari, Tommi

AU - Venketasubramanian, Narayanaswamy

AU - Vlassov, Vasiliy V.

AU - Wang, Wenzhi

AU - Werdecker, Andrea

AU - Wolfe, Charles D.A.

AU - Xu, Gelin

AU - Yano, Yuichiro

AU - Yonemoto, Naohiro

AU - Yu, Chuanhua

AU - Zaidi, Zoubida

AU - El Sayed Zaki, Maysaa

AU - Zhou, Maigeng

AU - Ziaeian, Boback

AU - Zipkin, Ben

AU - Vos, Theo

AU - Naghavi, Mohsen

AU - Murray, Christopher J.L.

AU - Global Burden of Disease Stroke Expert Group

PY - 2018/12/20

Y1 - 2018/12/20

N2 - BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

AB - BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

UR - http://www.scopus.com/inward/record.url?scp=85058877243&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1804492

DO - 10.1056/NEJMoa1804492

M3 - Article

VL - 379

SP - 2429

EP - 2437

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 25

ER -