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January 18, 2022; 98 (3) Research Article

Global, Regional, and National Burden of Ischemic Stroke, 1990–2019

Quanquan Ding, View ORCID ProfileShiwei Liu, Yindan Yao, Huina Liu, Ting Cai, Liyuan Han
First published December 15, 2021, DOI: https://doi.org/10.1212/WNL.0000000000013115
Quanquan Ding
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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Shiwei Liu
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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  • ORCID record for Shiwei Liu
Yindan Yao
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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Huina Liu
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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Ting Cai
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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Liyuan Han
From the Hwa Mei Hospital (Q.D., Y.Y., H.L., T.C., L.H.) and Department of Global Health (Q.D., H.L., T.C., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Zhejiang, PR China; Department of Medicine and Division of Hematology/Oncology (Q.D.), University of Pittsburgh, School of Medicine, PA; and National Center for Chronic and Noncommunicable Disease Control and Prevention (S.L.), Chinese Center for Disease Control and Prevention, Beijing, PR China.
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Global, Regional, and National Burden of Ischemic Stroke, 1990–2019
Quanquan Ding, Shiwei Liu, Yindan Yao, Huina Liu, Ting Cai, Liyuan Han
Neurology Jan 2022, 98 (3) e279-e290; DOI: 10.1212/WNL.0000000000013115

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Abstract

Background and Objectives To the best of our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. Thus, our objective was to examine ischemic stroke burden at the global, regional, and national levels in terms of sex, age, and social development index (SDI).

Methods Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and disability-adjusted life-years (DALY) trends of ischemic stroke. Measures were stratified by sex, region, country, age, and SDI.

Results The global age-standardized incidence rate (ASIR) of ischemic stroke decreased from 1990 to 2019, with an EAPC of −0.43 (95% confidence interval [CI] −0.54 to −0.32). High-middle and middle SDI regions had much higher ASIR, age-standardized death rate (ASDR), and age-standardized DALY rates due to ischemic stroke than other SDI regions. Regionally, East Asia had the highest ASIR of ischemic stroke in 2019 and the largest increase in the ASIR from 1990 to 2019. Nationally, Egypt (EAPC 1.40, 95% CI 1.27–1.52) and China (EAPC 1.10, 95% CI 1.00–1.20) had the most pronounced increases in the ASIR of ischemic stroke. Globally, there was an increase in ischemic stroke incidence with increasing age, especially in women 50 to 69 years of age or older. The global ASDR decreased from 1990 to 2019, with an EAPC of −1.63 (95% CI −1.72 to −1.53). The ASDR and age-standardized DALY rates increased most in southern sub-Saharan Africa, eastern sub-Saharan Africa, and southeast Asia.

Discussion The ASIR, ASDR, and age-standardized DALY rates remained high in high-middle and middle SDI regions. East Asia, southern sub-Saharan Africa, eastern sub-Saharan Africa, and Southeast Asia had the greatest burden of ischemic stroke.

Glossary

ASDR=
age-standardized death rate;
ASIR=
age-standardized incidence rate;
CI=
confidence interval;
DALY=
disability-adjusted life-year;
EAPC=
estimated annual percentage change;
GBD=
Global Burden of Disease;
LMICs=
low- and middle-income countries;
SDI=
social development index;
UI=
uncertainty interval

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 7, 2021.
  • Accepted in final form November 19, 2021.
  • © 2021 American Academy of Neurology
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