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Epidemiology of stroke

Epidemiology

Despite the fact that stroke is largely preventable, the global incidence of stroke is rising, there is still relatively low awareness of the risk factors1, and until recently, stroke has not been seen as a top healthcare priority.2,3 There is now increasing pressure on health authorities to focus more on non-communicable diseases, especially heart disease, stroke and diabetes, and introduce more effective measures to prevent stroke and optimise stroke care in line with international guidelines.4

Burden of stroke

Stroke is a devastating and debilitating disease. It is the second leading cause of death worldwide, exceeded only by ischaemic heart disease and a leading cause of adult disability.5,6

Burden of stroke

Over the past years, incidence, prevalence and mortality rates of ischaemic stroke changed substantially.7,8

Ischaemic stroke: incidence, prevalence and mortality rates of ischaemic stroke changed substantially

United States

In the US, each year approximately 795,000 people experience a new or recurrent stroke.5 In 2016, on average every 3 minutes 42 seconds a person died of stroke, accounting for ~ 1 in 19 deaths in the United States.5 From 2011 to 2014 the overall stroke prevalence was estimated at 2.7%.9

Europe

In Europe, stroke is the second leading cause of death responsible for 405,000 deaths in men and 583,000 deaths in women each year.9 Stroke accounts for nearly 14% of all new CVD cases in Europe with approximately 1.6 million new stroke cases in total.9 With 880,000 vs. 680,000 new cases the incidence is slightly higher in females than in males.9

China

In China, the incidence for all stroke types is 601.9 per 100,000 (age-adjusted).10 The prevalence ranges from 1.6% in rural areas to 9.3% in urban areas.11 In terms of mortality, stroke is responsible for 28.8% (urban) to 29.1% (rural) of all death in total - one of the highest rates worldwide.12

Geographical differences: Low-income vs. high-income countries

There are substantial geographical differences in the burden of stroke, with low- and middle-income countries bearing the highest burden of stroke.

  • In 2013, the number of deaths from stroke was 4.85 million in low- and middle-income countries compared to 1.6 million in high-income countries.13

  • Likewise, the number of DALYs in developing countries was 91.4 million versus 21.5 million in high-income countries.13

Proportional contribution (%) of ischaemic stroke (IS) to all health conditions by year and country development

Gender differences

A higher global incidence of ischaemic but not haemorrhagic stroke is reported in men than in women. The incidence rate in women has significantly decreased between 1990 and 2013, but in men the decrease was not significant.14

The number of DALYs lost to stroke is similar in men and in women, although the DALYs lost have increased in both sexes from 1990-2013.14

The financial burden of stroke

Total estimated costs of stroke in the United States is 45.5 billion USD, with 28.0 billion USD in direct medical costs.5

In 2015, total estimated costs of stroke in Europe were 45 billion € (20 billion € in direct healthcare costs; 15.9 billion € in informal care costs; 5.4 billion € costs due to productivity losses and 4 billion € from losses due to death).15

Costs of stroke in 2015 in the EU15

Costs of stroke in 2015 in the EU
References

  1. Feigin VL., et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Lond Engl 2014;383:245–254.

  2. Thrift AG., et al. Global stroke statistics. Int J Stroke Off J Int Stroke Soc 2014;9:6–18.

  3. Mensah GA., et al. The Global Burden of Stroke. Neuroepidemiology 2015;45:143–145.

  4. Norrving B., et al. Stroke Prevention Worldwide--What Could Make It Work? Neuroepidemiology 2015;45:215–220.

  5. Benjamin EJ., et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019;139:e56–e66.

  6. World Stroke Organisation (WSO). Global Strok Fact Sheet. 2019. Available at: https://www.world-stroke.org/images/WSO_Global_Stroke_Fact_Sheet.pdf

  7. Feigin VL., et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology 2015;45:161–176.

  8. Feigin VL., et al. Global Burden of Stroke. Circ Res 2017;120:439–448.

  9. Wilkins E., et al. European Cardiovascular Disease Statistics 2017. Eur Heart Netw Eur Soc Cardiol.

  10. Sun Z., et al. An epidemiological survey of stroke among rural Chinese adults results from the Liaoning province. Int J Stroke Off J Int Stroke Soc 2013;8:701–706.

  11. Ferri CP., et al. Prevalence of stroke and related burden among older people living in Latin America, India and China. J Neurol Neurosurg Psychiatry 2011;82:1074–1082.

  12. Ferri CP., et al. Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study. PLoS Med 2012;9:e1001179.

  13. WHO. CVD Atlas. 2004.

  14. Barker-Collo S., et al. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013. Neuroepidemiology 2015;45:203–214.

  15. King’s College London for the Stroke Alliance for Europe (SAFE). The burden of stroke in Europe - Report. 2017.

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