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This study looked at the burden of stroke on society, which is the incidence, death rate and the number of years lost due to disability and death (the Daily Adjusted Life Years, or DALYs). The data suggests that 7 million deaths in are attributable to stroke. This makes it the third highest cause of death, behind heart disease and COVID-19.
Globally, between 1990 and 2021, the number of new strokes increased 70%, and the number of people living with health loss due to stroke is up 32%.
It’s worth noting that the rate of stroke (number of strokes per 100 people) has decreased. However, population growth, and an aging population means the absolute number of strokes, and stroke survivors has risen sharply.
Also looked at are risk factors, such as high BMI, high blood pressure, air pollution and smoking. The authors suggest that since many of these factors can be eased to one degree or another, that stroke prevention strategies need to be changed.
Dr Eithne Sexton, Health Services Researcher and Lecturer in the School of Population Health at RCSI University of Medicine and Health Sciences, said:
“This new research published in the Lancet Neurology combines data from multiple sources to estimate the number of people globally who are living with stroke, or are dying or disabled due to stroke, and to identify the main factors responsible for causing strokes globally.
This research is very relevant to Ireland as it highlights the extent to which the number of people with stroke globally, and consequent need for stroke services, is rapidly increasing with population ageing. Ireland is no exception to this trend, and in fact the population in Ireland is ageing more rapidly than many other high-income countries. Stroke services in Ireland are already struggling to meet current need, especially when it comes to rehabilitation and other support services that people need after they leave hospital.
Addressing this growing need requires investment in services, but it also requires that we invest as much as possible in stroke prevention, so that services are not required in the first place. This study is one of the first to show the significant role of environmental causes of strokes, particularly ambient particulate matter pollution, or air pollution. In Western Europe, this type of air pollution was identified as causing more stroke-related disability than second-hand smoking. This highlights that in addition to addressing individual risk factors such as high blood pressure, smoking, diet and physical activity, we also need to actively work to reduce air pollution caused by things like road traffic, and the burning of solid fuels for home-heating.
Limitations
Although this study provides estimates of stroke incidence and prevalence that are specific to Ireland, it is important to note that the study methodology is geared towards producing global estimates, and the data sources and methods used may not be as accurate as a study that was more specifically focussed on Ireland.”
Professor David Williams, Professor of Stroke Medicine at RCSI University of Medicine and Health Sciences, said:
“’This important and far-reaching study provides up-to-date estimates of the burden of overall stroke worldwide and its associated risk factors. The burden of stroke has increased substantially from 1990 to 2021, due to a number of risk factors. This work will help guide future Health Services planning and preventative measures to reduce the incidence of stroke in the future.
From 1990 to 2021, the age-standardised incidence, death , prevalence, and Disability Associated Life Years(DALYs) rates of stroke were reduced in Ireland by 59%, 74%, 42% and 73% respectively.”
Dr Sara Hayes, Associate Professor of Physiotherapy at University of Limerick, said:
“The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is the only epidemiological study that produces comprehensive estimates of global, regional, and country-specific burden of stroke and its risk factors, including data specific to Ireland.
It provides crucial information for evidence-based health-care policy, planning, and resource allocation for stroke globally and in Ireland. It includes incidence (a measure of the number of new stroke cases in a population), prevalence (the proportion of a population who have stroke) in a specified period, death, disability and risk factors for stroke.
Main findings demonstrate that stroke burden, in terms of absolute numbers, has increased substantially from 1990 to 2021. Stroke remains the second most common cause of death and the third most common cause of disability globally. In Ireland in 2021 there were 4000 new incident cases of stroke, 2000 deaths related to stroke and 43000 people living with stroke. Overall, from 1990 to 2021, there was an increase in the contribution to stroke disability from key risk factors including: high body mass index, high ambient temperature, high fasting plasma glucose, diet high in sugar-sweetened beverages, low physical activity, high systolic blood pressure, and diet low in omega-6 polyunsaturated fatty acids. Stroke burden was highest in low-income and middle-income countries. While the burden of stroke in Ireland is rising, it is in line with other high-income European countries.
The findings of this comprehensive study highlight that the large and continued rise in the global burden of stroke presents many challenges to governments and health-care systems worldwide that need to be urgently addressed. Globally and in an Irish context, there is an urgent need for improved stroke surveillance, prevention (with the emphasis on elevated blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation to reduce stroke burden. In line with these findings, a recent Irish National Audit of Stroke annual report (2022) has outlined that while some improvements have been made in stroke care in Ireland, the continued failure to admit a large proportion of people with a stroke to a stroke unit is a concern, and has recommended that the National Stroke Strategy (2022-2027) (which is yet to be fully funded) and its recommendations for increasing resources and clinical facilities for stroke be fully implemented in Ireland.
One point of caveat relates to the GBD methods for estimating attributable burden of stroke due to risk factors accounts for a cumulative effect of multiple risk factors, it might not fully account for all potential confounders.”
‘Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021’ by the GBD 2021 Stroke Collabor was published in The Lancet Neurology at 23:30 Irish time Wednesday 18th September 2024.