GB Stroke 1990-2013 in 188 countries

Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Prof Valery L Feigin, MD

,

Gregory A Roth, MD

,

Prof Mohsen Naghavi, MD

,

Priya Parmar, PhD

,

Rita Krishnamurthi, PhD

,

Sumeet Chugh, MD

,

George A Mensah, MD

,

Prof Bo Norrving, MD

,

Ivy Shiue, PhD

,

Marie Ng, PhD

,

Kara Estep, BA

,

Kelly Cercy, BA

,

Prof Christopher J L Murray, MD

,

Prof Mohammad H Forouzanfar, PhD

 for the Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group†

†Members listed at the end of the Article

Published Online: 09 June 2016

DOI: http://dx.doi.org/10.1016/S1474-4422(16)30073-4

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Summary

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Background

The contribution of modifiable risk factors to the increasing global and regional burden of stroke is unclear, but knowledge about this contribution is crucial for informing stroke prevention strategies. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the population-attributable fraction (PAF) of stroke-related disability-adjusted life-years (DALYs) associated with potentially modifiable environmental, occupational, behavioural, physiological, and metabolic risk factors in different age and sex groups worldwide and in high-income countries and low-income and middle-income countries, from 1990 to 2013.

Methods

We used data on stroke-related DALYs, risk factors, and PAF from the GBD 2013 Study to estimate the burden of stroke by age and sex (with corresponding 95% uncertainty intervals [UI]) in 188 countries, as measured with stroke-related DALYs in 1990 and 2013. We evaluated attributable DALYs for 17 risk factors (air pollution and environmental, dietary, physical activity, tobacco smoke, and physiological) and six clusters of risk factors by use of three inputs: risk factor exposure, relative risks, and the theoretical minimum risk exposure level. For most risk factors, we synthesised data for exposure with a Bayesian meta-regression method (DisMod-MR) or spatial-temporal Gaussian process regression. We based relative risks on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks, such as high body-mass index (BMI), through other risks, such as high systolic blood pressure (SBP) and high total cholesterol.

Findings

Globally, 90·5% (95% UI 88·5–92·2) of the stroke burden (as measured in D