Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Stroke Collaborators

doi:10.1016/S1474-4422(19)30034-1

Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Stroke Collaborators

Research output: Contribution to journal › Article › Research › peer-review

2026 Citations (Scopus)

Abstract

Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation

Original language	English
Pages (from-to)	439-458
Number of pages	20
Journal	The Lancet Neurology
Volume	18
Issue number	5
DOIs	https://doi.org/10.1016/S1474-4422(19)30034-1
Publication status	Published - 1 May 2019

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10.1016/S1474-4422(19)30034-1

271682894-oaFinal published version, 1.37 MBLicence: CC BY

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@article{836d342d04dc4c77adae90792d30b06b,

title = "Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016",

abstract = "Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation",

author = "Johnson, {Catherine Owens} and Minh Nguyen and Roth, {Gregory A.} and Emma Nichols and Tahiya Alam and Degu Abate and Foad Abd-Allah and Ahmed Abdelalim and Abraha, {Haftom Niguse} and Abu-Rmeileh, {Niveen ME} and Adebayo, {Oladimeji M.} and Adeoye, {Abiodun Moshood} and Gina Agarwal and Sutapa Agrawal and Aichour, {Amani Nidhal} and Ibtihel Aichour and Aichour, {Miloud Taki Eddine} and Fares Alahdab and Raghib Ali and Nelson Alvis-Guzman and Anber, {Nahla Hamed} and Mina Anjomshoa and Jalal Arabloo and Antonio Arauz and Johan {\"A}rnl{\"o}v and Amit Arora and Ashish Awasthi and Maciej Banach and Barboza, {Miguel A.} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Sanjay Basu and Belachew, {Abate Bekele} and Belayneh, {Yaschilal Muche} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Krittika Bhattacharyya and Belete Biadgo and Ali Bijani and Boris Bikbov and {Bin Sayeed}, {Muhammad Shahdaat} and Butt, {Zahid A.} and Lucero Cahuana-Hurtado and Carrero, {Juan J.} and F{\'e}lix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and Franz Castro and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Yazan Chaiah and Chiang, {Peggy Pei Chia} and Choi, {Jee Young J.} and Hanne Christensen and Chu, {Dinh Toi} and Monica Cortinovis and Damasceno, {Albertino Antonio Moura} and Lalit Dandona and Rakhi Dandona and Ahmad Daryani and Kairat Davletov and {de Courten}, Barbora and {De la Cruz-G{\'o}ngora}, Vanessa and Degefa, {Meaza Girma} and Dharmaratne, {Samath Dhamminda} and Daniel Diaz and Manisha Dubey and Duken, {Eyasu Ejeta} and Dumessa Edessa and Matthias Endres and FARAON, {EMERITO JOSE A.} and Farshad Farzadfar and Eduarda Fernandes and Florian Fischer and Flor, {Luisa Sorio} and Morsaleh Ganji and Gebre, {Abadi Kahsu} and Gebremichael, {Teklu Gebrehiwo} and Birhanu Geta and Gezae, {Kebede Embaye} and Gill, {Paramjit Singh} and Gnedovskaya, {Elena V.} and Hector G{\'o}mez-Dant{\'e}s and Goulart, {Alessandra C.} and Giuseppe Grosso and Yuming Guo and Rajeev Gupta and Arvin Haj-Mirzaian and Arya Haj-Mirzaian and Samer Hamidi and Hankey, {Graeme J.} and Hassen, {Hamid Yimam} and Hay, {Simon I.} and Hegazy, {Mohamed I.} and Behnam Heidari and Herial, {Nabeel A.} and Hosseini, {Mohammad Ali} and Sorin Hostiuc and Irvani, {Seyed Sina Naghibi} and Islam, {Sheikh Mohammed Shariful} and Nader Jahanmehr and Mehdi Javanbakht and Jha, {Ravi Prakash} and Jonas, {Jost B.} and Jozwiak, {Jacek Jerzy} and Mikk J{\"u}risson and Amaha Kahsay and Rizwan Kalani and Yogeshwar Kalkonde and Kamil, {Teshome Abegaz} and Tanuj Kanchan and Andr{\'e} Karch and Narges Karimi and Hamidreza Karimi-Sari and Amir Kasaeian and Kassa, {Tesfaye Dessale} and Hossein Kazemeini and Kefale, {Adane Teshome} and Khader, {Yousef Saleh} and Khalil, {Ibrahim A.} and Khan, {Ejaz Ahmad} and Khang, {Young Ho} and Jagdish Khubchandani and Daniel Kim and Kim, {Yun Jin} and Adnan Kisa and Mika Kivim{\"a}ki and Ai Koyanagi and Krishnamurthi, {Rita K.} and Kumar, {G. Anil} and Alessandra Lafranconi and Sarah Lewington and Shanshan Li and Lo, {Warren David} and Lopez, {Alan D.} and Stefan Lorkowski and Lotufo, {Paulo A.} and Mackay, {Mark T.} and Marek Majdan and Reza Majdzadeh and Azeem Majeed and Reza Malekzadeh and Navid Manafi and Mansournia, {Mohammad Ali} and Mehndiratta, {Man Mohan} and Varshil Mehta and Getnet Mengistu and Atte Meretoja and Meretoja, {Tuomo J.} and Bartosz Miazgowski and Tomasz Miazgowski and Miller, {Ted R.} and Mirrakhimov, {Erkin M.} and Bahram Mohajer and Yousef Mohammad and Milad Mohammadoo-khorasani and Shafiu Mohammed and Farnam Mohebi and Mokdad, {Ali H.} and Yaser Mokhayeri and Ghobad Moradi and Lidia Morawska and {Moreno Vel{\'a}squez}, Ilais and Mousavi, {Seyyed Meysam} and Muhammed, {Oumer Sada S.} and Walter Muruet and Mehdi Naderi and Mohsen Naghavi and Gurudatta Naik and Nascimento, {Bruno Ramos} and Negoi, {Ruxandra Irina} and Nguyen, {Cuong Tat} and Nguyen, {Long Hoang} and Nirayo, {Yirga Legesse} and Bo Norrving and Noubiap, {Jean Jacques} and Richard Ofori-Asenso and Ogbo, {Felix Akpojene} and Olagunju, {Andrew T.} and Olagunju, {Tinuke O.} and Owolabi, {Mayowa Ojo} and Pandian, {Jeyaraj Durai} and Shanti Patel and Norberto Perico and Piradov, {Michael A.} and Suzanne Polinder and Postma, {Maarten J.} and Hossein Poustchi and V. Prakash and Mostafa Qorbani and Alireza Rafiei and Fakher Rahim and Kazem Rahimi and Vafa Rahimi-Movaghar and Mahfuzar Rahman and Rahman, {Muhammad Aziz} and Cesar Reis and Giuseppe Remuzzi and Renzaho, {Andre M.N.} and Stefano Ricci and Roberts, {Nicholas L.S.} and Robinson, {Stephen R.} and Leonardo Roever and Gholamreza Roshandel and Parisa Sabbagh and Hosein Safari and Saeed Safari and Saeid Safiri and Amirhossein Sahebkar and {Salehi Zahabi}, Saleh and Samy, {Abdallah M.} and Paola Santalucia and Santos, {Itamar S.} and Santos, {Jo{\~a}o Vasco} and {Santric Milicevic}, {Milena M.} and Benn Sartorius and Sawant, {Arundhati R.} and Schutte, {Aletta Elisabeth} and Sepanlou, {Sadaf G.} and Azadeh Shafieesabet and Shaikh, {Masood Ali} and Mehran Shams-Beyranvand and Aziz Sheikh and Sheth, {Kevin N.} and Kenji Shibuya and Mika Shigematsu and Shin, {Min Jeong} and Ivy Shiue and Soraya Siabani and Sobaih, {Badr Hasan} and Sposato, {Luciano A.} and Ipsita Sutradhar and Sylaja, {P. N.} and Szoeke, {Cassandra E.I.} and {Te Ao}, {Braden James} and Temsah, {Mohamad Hani} and Omar Temsah and Thrift, {Amanda G.} and Marcello Tonelli and Roman Topor-Madry and Tran, {Bach Xuan} and Tran, {Khanh Bao} and Truelsen, {Thomas Clement} and Tsadik, {Afewerki Gebremeskel} and Irfan Ullah and Uthman, {Olalekan A.} and Muthiah Vaduganathan and Valdez, {Pascual R.} and Vasankari, {Tommi Juhani} and Rajagopalan Vasanthan and Narayanaswamy Venketasubramanian and Kia Vosoughi and {GBD 2016 Stroke Collaborators}",

year = "2019",

month = may,

day = "1",

doi = "10.1016/S1474-4422(19)30034-1",

language = "English",

volume = "18",

pages = "439--458",

journal = "The Lancet Neurology",

issn = "1474-4422",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Global, regional, and national burden of stroke, 1990–2016

T2 - a systematic analysis for the Global Burden of Disease Study 2016

AU - Johnson, Catherine Owens

AU - Nguyen, Minh

AU - Roth, Gregory A.

AU - Nichols, Emma

AU - Alam, Tahiya

AU - Abate, Degu

AU - Abd-Allah, Foad

AU - Abdelalim, Ahmed

AU - Abraha, Haftom Niguse

AU - Abu-Rmeileh, Niveen ME

AU - Adebayo, Oladimeji M.

AU - Adeoye, Abiodun Moshood

AU - Agarwal, Gina

AU - Agrawal, Sutapa

AU - Aichour, Amani Nidhal

AU - Aichour, Ibtihel

AU - Aichour, Miloud Taki Eddine

AU - Alahdab, Fares

AU - Ali, Raghib

AU - Alvis-Guzman, Nelson

AU - Anber, Nahla Hamed

AU - Anjomshoa, Mina

AU - Arabloo, Jalal

AU - Arauz, Antonio

AU - Ärnlöv, Johan

AU - Arora, Amit

AU - Awasthi, Ashish

AU - Banach, Maciej

AU - Barboza, Miguel A.

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Basu, Sanjay

AU - Belachew, Abate Bekele

AU - Belayneh, Yaschilal Muche

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Bhattacharyya, Krittika

AU - Biadgo, Belete

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Bin Sayeed, Muhammad Shahdaat

AU - Butt, Zahid A.

AU - Cahuana-Hurtado, Lucero

AU - Carrero, Juan J.

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Castro, Franz

AU - Catalá-López, Ferrán

AU - Chaiah, Yazan

AU - Chiang, Peggy Pei Chia

AU - Choi, Jee Young J.

AU - Christensen, Hanne

AU - Chu, Dinh Toi

AU - Cortinovis, Monica

AU - Damasceno, Albertino Antonio Moura

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Daryani, Ahmad

AU - Davletov, Kairat

AU - de Courten, Barbora

AU - De la Cruz-Góngora, Vanessa

AU - Degefa, Meaza Girma

AU - Dharmaratne, Samath Dhamminda

AU - Diaz, Daniel

AU - Dubey, Manisha

AU - Duken, Eyasu Ejeta

AU - Edessa, Dumessa

AU - Endres, Matthias

AU - FARAON, EMERITO JOSE A.

AU - Farzadfar, Farshad

AU - Fernandes, Eduarda

AU - Fischer, Florian

AU - Flor, Luisa Sorio

AU - Ganji, Morsaleh

AU - Gebre, Abadi Kahsu

AU - Gebremichael, Teklu Gebrehiwo

AU - Geta, Birhanu

AU - Gezae, Kebede Embaye

AU - Gill, Paramjit Singh

AU - Gnedovskaya, Elena V.

AU - Gómez-Dantés, Hector

AU - Goulart, Alessandra C.

AU - Grosso, Giuseppe

AU - Guo, Yuming

AU - Gupta, Rajeev

AU - Haj-Mirzaian, Arvin

AU - Haj-Mirzaian, Arya

AU - Hamidi, Samer

AU - Hankey, Graeme J.

AU - Hassen, Hamid Yimam

AU - Hay, Simon I.

AU - Hegazy, Mohamed I.

AU - Heidari, Behnam

AU - Herial, Nabeel A.

AU - Hosseini, Mohammad Ali

AU - Hostiuc, Sorin

AU - Irvani, Seyed Sina Naghibi

AU - Islam, Sheikh Mohammed Shariful

AU - Jahanmehr, Nader

AU - Javanbakht, Mehdi

AU - Jha, Ravi Prakash

AU - Jonas, Jost B.

AU - Jozwiak, Jacek Jerzy

AU - Jürisson, Mikk

AU - Kahsay, Amaha

AU - Kalani, Rizwan

AU - Kalkonde, Yogeshwar

AU - Kamil, Teshome Abegaz

AU - Kanchan, Tanuj

AU - Karch, André

AU - Karimi, Narges

AU - Karimi-Sari, Hamidreza

AU - Kasaeian, Amir

AU - Kassa, Tesfaye Dessale

AU - Kazemeini, Hossein

AU - Kefale, Adane Teshome

AU - Khader, Yousef Saleh

AU - Khalil, Ibrahim A.

AU - Khan, Ejaz Ahmad

AU - Khang, Young Ho

AU - Khubchandani, Jagdish

AU - Kim, Daniel

AU - Kim, Yun Jin

AU - Kisa, Adnan

AU - Kivimäki, Mika

AU - Koyanagi, Ai

AU - Krishnamurthi, Rita K.

AU - Kumar, G. Anil

AU - Lafranconi, Alessandra

AU - Lewington, Sarah

AU - Li, Shanshan

AU - Lo, Warren David

AU - Lopez, Alan D.

AU - Lorkowski, Stefan

AU - Lotufo, Paulo A.

AU - Mackay, Mark T.

AU - Majdan, Marek

AU - Majdzadeh, Reza

AU - Majeed, Azeem

AU - Malekzadeh, Reza

AU - Manafi, Navid

AU - Mansournia, Mohammad Ali

AU - Mehndiratta, Man Mohan

AU - Mehta, Varshil

AU - Mengistu, Getnet

AU - Meretoja, Atte

AU - Meretoja, Tuomo J.

AU - Miazgowski, Bartosz

AU - Miazgowski, Tomasz

AU - Miller, Ted R.

AU - Mirrakhimov, Erkin M.

AU - Mohajer, Bahram

AU - Mohammad, Yousef

AU - Mohammadoo-khorasani, Milad

AU - Mohammed, Shafiu

AU - Mohebi, Farnam

AU - Mokdad, Ali H.

AU - Mokhayeri, Yaser

AU - Moradi, Ghobad

AU - Morawska, Lidia

AU - Moreno Velásquez, Ilais

AU - Mousavi, Seyyed Meysam

AU - Muhammed, Oumer Sada S.

AU - Muruet, Walter

AU - Naderi, Mehdi

AU - Naghavi, Mohsen

AU - Naik, Gurudatta

AU - Nascimento, Bruno Ramos

AU - Negoi, Ruxandra Irina

AU - Nguyen, Cuong Tat

AU - Nguyen, Long Hoang

AU - Nirayo, Yirga Legesse

AU - Norrving, Bo

AU - Noubiap, Jean Jacques

AU - Ofori-Asenso, Richard

AU - Ogbo, Felix Akpojene

AU - Olagunju, Andrew T.

AU - Olagunju, Tinuke O.

AU - Owolabi, Mayowa Ojo

AU - Pandian, Jeyaraj Durai

AU - Patel, Shanti

AU - Perico, Norberto

AU - Piradov, Michael A.

AU - Polinder, Suzanne

AU - Postma, Maarten J.

AU - Poustchi, Hossein

AU - Prakash, V.

AU - Qorbani, Mostafa

AU - Rafiei, Alireza

AU - Rahim, Fakher

AU - Rahimi, Kazem

AU - Rahimi-Movaghar, Vafa

AU - Rahman, Mahfuzar

AU - Rahman, Muhammad Aziz

AU - Reis, Cesar

AU - Remuzzi, Giuseppe

AU - Renzaho, Andre M.N.

AU - Ricci, Stefano

AU - Roberts, Nicholas L.S.

AU - Robinson, Stephen R.

AU - Roever, Leonardo

AU - Roshandel, Gholamreza

AU - Sabbagh, Parisa

AU - Safari, Hosein

AU - Safari, Saeed

AU - Safiri, Saeid

AU - Sahebkar, Amirhossein

AU - Salehi Zahabi, Saleh

AU - Samy, Abdallah M.

AU - Santalucia, Paola

AU - Santos, Itamar S.

AU - Santos, João Vasco

AU - Santric Milicevic, Milena M.

AU - Sartorius, Benn

AU - Sawant, Arundhati R.

AU - Schutte, Aletta Elisabeth

AU - Sepanlou, Sadaf G.

AU - Shafieesabet, Azadeh

AU - Shaikh, Masood Ali

AU - Shams-Beyranvand, Mehran

AU - Sheikh, Aziz

AU - Sheth, Kevin N.

AU - Shibuya, Kenji

AU - Shigematsu, Mika

AU - Shin, Min Jeong

AU - Shiue, Ivy

AU - Siabani, Soraya

AU - Sobaih, Badr Hasan

AU - Sposato, Luciano A.

AU - Sutradhar, Ipsita

AU - Sylaja, P. N.

AU - Szoeke, Cassandra E.I.

AU - Te Ao, Braden James

AU - Temsah, Mohamad Hani

AU - Temsah, Omar

AU - Thrift, Amanda G.

AU - Tonelli, Marcello

AU - Topor-Madry, Roman

AU - Tran, Bach Xuan

AU - Tran, Khanh Bao

AU - Truelsen, Thomas Clement

AU - Tsadik, Afewerki Gebremeskel

AU - Ullah, Irfan

AU - Uthman, Olalekan A.

AU - Vaduganathan, Muthiah

AU - Valdez, Pascual R.

AU - Vasankari, Tommi Juhani

AU - Vasanthan, Rajagopalan

AU - Venketasubramanian, Narayanaswamy

AU - Vosoughi, Kia

AU - GBD 2016 Stroke Collaborators

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation

AB - Background: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods: We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings: In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation: Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding: Bill & Melinda Gates Foundation

UR - http://www.scopus.com/inward/record.url?scp=85063992632&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(19)30034-1

DO - 10.1016/S1474-4422(19)30034-1

M3 - Article

AN - SCOPUS:85063992632

SN - 1474-4422

VL - 18

SP - 439

EP - 458

JO - The Lancet Neurology

JF - The Lancet Neurology

IS - 5

ER -

Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

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