Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

Gregory A. Roth; Valery L. Feigin; Grant Nguyen; Kelly Cercy; Catherine O. Johnson; Tahiya Alam; Priyakumari G. Parmar; Amanuel A. Abajobir; Kalkidan H. Abate; Foad Abd-Allah; Ayenew N. Abejie; Gebre Y. Abyu; Zanfina Ademi; Gina Agarwal; Muktar B. Ahmed; Rufus O. Akinyemi; Rajaa Al-Raddadi; Leopold N. Aminde; Catherine Amlie-Lefond; Hossein Ansari; Hamid Asayesh; Solomon W. Asgedom; Tesfay M. Atey; Henok T. Ayele; Maciej Banach; Amitava Banerjee; Aleksandra Barac; Suzanne L. Barker-Collo; Till Bärnighausen; Lars Barregard; Sanjay Basu; Neeraj Bedi; Masoud Behzadifar; Yannick Béjot; Derrick A. Bennett; Isabela M. Bensenor; Derbew F. Berhe; Dube J. Boneya; Michael Brainin; Ismael R. Campos-Nonato; Valeria Caso; Carlos A. Castañeda-Orjuela; Jacquelin C. Rivas; Ferrán Catalá-López; Hanne Christensen; Michael H. Criqui; Albertino Damasceno; Lalit Dandona; Rakhi Dandona; Kairat Davletov; Barbora de Courten; Gabrielle deVeber; Klara Dokova; Dumessa Edessa; Matthias Endres; Emerito J.A. Faraon; Maryam S. Farvid; Florian Fischer; Kyle Foreman; Mohammad H. Forouzanfar; Seana L. Gall; Tsegaye T. Gebrehiwot; Johanna M. Geleijnse; Richard F. Gillum; Maurice Giroud; Alessandra C. Goulart; Rajeev Gupta; Rajeev Gupta; Vladimir Hachinski; Randah R. Hamadeh; Graeme J. Hankey; Habtamu A. Hareri; Rasmus Havmoeller; Simon I. Hay; Mohamed I. Hegazy; Desalegn T. Hibstu; Spencer L. James; Panniyammakal Jeemon; Denny John; Jost B. Jonas; Jacek Jóźwiak; Rizwan Kalani; Amit Kandel; Amir Kasaeian; Andre P. Kengne; Yousef S. Khader; Abdur R. Khan; Young Ho Khang; Jagdish Khubchandani; Daniel Kim; Yun J. Kim; Mika Kivimaki; Yoshihiro Kokubo; Dhaval Kolte; Jacek A. Kopec; Soewarta Kosen; Michael Kravchenko; Rita Krishnamurthi; G. Anil Kumar; Alessandra Lafranconi; Pablo M. Lavados; Yirga Legesse; Yongmei Li; Xiaofeng Liang; Warren D. Lo; Stefan Lorkowski; Paulo A. Lotufo; Clement T. Loy; Mark T. Mackay; Hassan Magdy Abd El Razek; Mahdi Mahdavi; Azeem Majeed; Reza Malekzadeh; Deborah C. Malta; Abdullah A. Mamun; Lorenzo G. Mantovani; Sheila C.O. Martins; Kedar K. Mate; Mohsen Mazidi; Suresh Mehata; Toni Meier; Yohannes A. Melaku; Walter Mendoza; George A. Mensah; Atte Meretoja; Haftay B. Mezgebe; Tomasz Miazgowski; Ted R. Miller; Norlinah M. Ibrahim; Shafiu Mohammed; Ali H. Mokdad; Mahmood Moosazadeh; Andrew E. Moran; Kamarul I. Musa; Ruxandra I. Negoi; Minh Nguyen; Quyen L. Nguyen; Trang H. Nguyen; Tung T. Tran; Thanh T. Nguyen; Dina Nur Anggraini Ningrum; Bo Norrving; Jean J. Noubiap; Martin J. O'Donnell; Andrew T. Olagunju; Oyere K. Onuma; Mayowa O. Owolabi; Mahboubeh Parsaeian; George C. Patton; Michael Piradov; Martin A. Pletcher; Farshad Pourmalek; V. Prakash; Mostafa Qorbani; Mahfuzar Rahman; Muhammad A. Rahman; Rajesh K. Rai; Annemarei Ranta; David Rawaf; Salman Rawaf; Andre M.N. Renzaho; Stephen R. Robinson; Ramesh Sahathevan; Amirhossein Sahebkar; Joshua A. Salomon; Paola Santalucia; Itamar S. Santos; Benn Sartorius; Aletta E. Schutte; Sadaf G. Sepanlou; Azadeh Shafieesabet; Masood A. Shaikh; Morteza Shamsizadeh; Kevin N. Sheth; Mekonnen Sisay; Min Jeong Shin; Ivy Shiue; Diego A.S. Silva; Eugene Sobngwi; Michael Soljak; Reed J.D. Sorensen; Luciano A. Sposato; Saverio Stranges; Rizwan A. Suliankatchi; Rafael Tabarés-Seisdedos; David Tanne; Cuong Tat Nguyen; J. S. Thakur; Amanda G. Thrift; David L. Tirschwell; Roman Topor-Madry; Bach X. Tran; Luong T. Nguyen; Thomas Truelsen; Nikolaos Tsilimparis; Stefanos Tyrovolas; Kingsley N. Ukwaja; Olalekan A. Uthman; Yuri Varakin; Tommi Vasankari; Narayanaswamy Venketasubramanian; Vasiliy V. Vlassov; Wenzhi Wang; Andrea Werdecker; Charles D.A. Wolfe; Gelin Xu; Yuichiro Yano; Naohiro Yonemoto; Chuanhua Yu; Zoubida Zaidi; Maysaa El Sayed Zaki; Maigeng Zhou; Boback Ziaeian; Ben Zipkin; Theo Vos; Mohsen Naghavi; Christopher J.L. Murray

doi:10.1056/NEJMoa1804492

Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

Gregory A. Roth, Valery L. Feigin, Grant Nguyen, Kelly Cercy, Catherine O. Johnson, Tahiya Alam, Priyakumari G. Parmar, Amanuel A. Abajobir, Kalkidan H. Abate, Foad Abd-Allah, Ayenew N. Abejie, Gebre Y. Abyu, Zanfina Ademi, Gina Agarwal, Muktar B. Ahmed, Rufus O. Akinyemi, Rajaa Al-Raddadi, Leopold N. Aminde, Catherine Amlie-Lefond, Hossein AnsariHamid Asayesh, Solomon W. Asgedom, Tesfay M. Atey, Henok T. Ayele, Maciej Banach, Amitava Banerjee, Aleksandra Barac, Suzanne L. Barker-Collo, Till Bärnighausen, Lars Barregard, Sanjay Basu, Neeraj Bedi, Masoud Behzadifar, Yannick Béjot, Derrick A. Bennett, Isabela M. Bensenor, Derbew F. Berhe, Dube J. Boneya, Michael Brainin, Ismael R. Campos-Nonato, Valeria Caso, Carlos A. Castañeda-Orjuela, Jacquelin C. Rivas, Ferrán Catalá-López, Hanne Christensen, Michael H. Criqui, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Barbora de Courten, Gabrielle deVeber, Klara Dokova, Dumessa Edessa, Matthias Endres, Emerito J.A. Faraon, Maryam S. Farvid, Florian Fischer, Kyle Foreman, Mohammad H. Forouzanfar, Seana L. Gall, Tsegaye T. Gebrehiwot, Johanna M. Geleijnse, Richard F. Gillum, Maurice Giroud, Alessandra C. Goulart, Rajeev Gupta, Rajeev Gupta, Vladimir Hachinski, Randah R. Hamadeh, Graeme J. Hankey, Habtamu A. Hareri, Rasmus Havmoeller, Simon I. Hay, Mohamed I. Hegazy, Desalegn T. Hibstu, Spencer L. James, Panniyammakal Jeemon, Denny John, Jost B. Jonas, Jacek Jóźwiak, Rizwan Kalani, Amit Kandel, Amir Kasaeian, Andre P. Kengne, Yousef S. Khader, Abdur R. Khan, Young Ho Khang, Jagdish Khubchandani, Daniel Kim, Yun J. Kim, Mika Kivimaki, Yoshihiro Kokubo, Dhaval Kolte, Jacek A. Kopec, Soewarta Kosen, Michael Kravchenko, Rita Krishnamurthi, G. Anil Kumar, Alessandra Lafranconi, Pablo M. Lavados, Yirga Legesse, Yongmei Li, Xiaofeng Liang, Warren D. Lo, Stefan Lorkowski, Paulo A. Lotufo, Clement T. Loy, Mark T. Mackay, Hassan Magdy Abd El Razek, Mahdi Mahdavi, Azeem Majeed, Reza Malekzadeh, Deborah C. Malta, Abdullah A. Mamun, Lorenzo G. Mantovani, Sheila C.O. Martins, Kedar K. Mate, Mohsen Mazidi, Suresh Mehata, Toni Meier, Yohannes A. Melaku, Walter Mendoza, George A. Mensah, Atte Meretoja, Haftay B. Mezgebe, Tomasz Miazgowski, Ted R. Miller, Norlinah M. Ibrahim, Shafiu Mohammed, Ali H. Mokdad, Mahmood Moosazadeh, Andrew E. Moran, Kamarul I. Musa, Ruxandra I. Negoi, Minh Nguyen, Quyen L. Nguyen, Trang H. Nguyen, Tung T. Tran, Thanh T. Nguyen, Dina Nur Anggraini Ningrum, Bo Norrving, Jean J. Noubiap, Martin J. O'Donnell, Andrew T. Olagunju, Oyere K. Onuma, Mayowa O. Owolabi, Mahboubeh Parsaeian, George C. Patton, Michael Piradov, Martin A. Pletcher, Farshad Pourmalek, V. Prakash, Mostafa Qorbani, Mahfuzar Rahman, Muhammad A. Rahman, Rajesh K. Rai, Annemarei Ranta, David Rawaf, Salman Rawaf, Andre M.N. Renzaho, Stephen R. Robinson, Ramesh Sahathevan, Amirhossein Sahebkar, Joshua A. Salomon, Paola Santalucia, Itamar S. Santos, Benn Sartorius, Aletta E. Schutte, Sadaf G. Sepanlou, Azadeh Shafieesabet, Masood A. Shaikh, Morteza Shamsizadeh, Kevin N. Sheth, Mekonnen Sisay, Min Jeong Shin, Ivy Shiue, Diego A.S. Silva, Eugene Sobngwi, Michael Soljak, Reed J.D. Sorensen, Luciano A. Sposato, Saverio Stranges, Rizwan A. Suliankatchi, Rafael Tabarés-Seisdedos, David Tanne, Cuong Tat Nguyen, J. S. Thakur, Amanda G. Thrift, David L. Tirschwell, Roman Topor-Madry, Bach X. Tran, Luong T. Nguyen, Thomas Truelsen, Nikolaos Tsilimparis, Stefanos Tyrovolas, Kingsley N. Ukwaja, Olalekan A. Uthman, Yuri Varakin, Tommi Vasankari, Narayanaswamy Venketasubramanian, Vasiliy V. Vlassov, Wenzhi Wang, Andrea Werdecker, Charles D.A. Wolfe, Gelin Xu, Yuichiro Yano, Naohiro Yonemoto, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Maigeng Zhou, Boback Ziaeian, Ben Zipkin, Theo Vos, Mohsen Naghavi, Christopher J.L. Murray

Research output: Journal article publication › Journal article › Academic research › peer-review

1043 Citations (Scopus)

Abstract

BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

Original language	English
Pages (from-to)	2429-2437
Number of pages	9
Journal	New England Journal of Medicine
Volume	379
Issue number	25
DOIs	https://doi.org/10.1056/NEJMoa1804492
Publication status	Published - 20 Dec 2018
Externally published	Yes

ASJC Scopus subject areas

General Medicine

More information

10.1056/NEJMoa1804492

Cite this

Roth, G. A., Feigin, V. L., Nguyen, G., Cercy, K., Johnson, C. O., Alam, T., Parmar, P. G., Abajobir, A. A., Abate, K. H., Abd-Allah, F., Abejie, A. N., Abyu, G. Y., Ademi, Z., Agarwal, G., Ahmed, M. B., Akinyemi, R. O., Al-Raddadi, R., Aminde, L. N., Amlie-Lefond, C., ... Murray, C. J. L. (2018). Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. New England Journal of Medicine, 379(25), 2429-2437. https://doi.org/10.1056/NEJMoa1804492

@article{7e43945c736544e4af88883d177bedef,

title = "Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016",

abstract = "BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.",

author = "Roth, {Gregory A.} and Feigin, {Valery L.} and Grant Nguyen and Kelly Cercy and Johnson, {Catherine O.} and Tahiya Alam and Parmar, {Priyakumari G.} and Abajobir, {Amanuel A.} and Abate, {Kalkidan H.} and Foad Abd-Allah and Abejie, {Ayenew N.} and Abyu, {Gebre Y.} and Zanfina Ademi and Gina Agarwal and Ahmed, {Muktar B.} and Akinyemi, {Rufus O.} and Rajaa Al-Raddadi and Aminde, {Leopold N.} and Catherine Amlie-Lefond and Hossein Ansari and Hamid Asayesh and Asgedom, {Solomon W.} and Atey, {Tesfay M.} and Ayele, {Henok T.} and Maciej Banach and Amitava Banerjee and Aleksandra Barac and Barker-Collo, {Suzanne L.} and Till B{\"a}rnighausen and Lars Barregard and Sanjay Basu and Neeraj Bedi and Masoud Behzadifar and Yannick B{\'e}jot and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Berhe, {Derbew F.} and Boneya, {Dube J.} and Michael Brainin and Campos-Nonato, {Ismael R.} and Valeria Caso and Casta{\~n}eda-Orjuela, {Carlos A.} and Rivas, {Jacquelin C.} and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Hanne Christensen and Criqui, {Michael H.} and Albertino Damasceno and Lalit Dandona and Rakhi Dandona and Kairat Davletov and {de Courten}, Barbora and Gabrielle deVeber and Klara Dokova and Dumessa Edessa and Matthias Endres and Faraon, {Emerito J.A.} and Farvid, {Maryam S.} and Florian Fischer and Kyle Foreman and Forouzanfar, {Mohammad H.} and Gall, {Seana L.} and Gebrehiwot, {Tsegaye T.} and Geleijnse, {Johanna M.} and Gillum, {Richard F.} and Maurice Giroud and Goulart, {Alessandra C.} and Rajeev Gupta and Rajeev Gupta and Vladimir Hachinski and Hamadeh, {Randah R.} and Hankey, {Graeme J.} and Hareri, {Habtamu A.} and Rasmus Havmoeller and Hay, {Simon I.} and Hegazy, {Mohamed I.} and Hibstu, {Desalegn T.} and James, {Spencer L.} and Panniyammakal Jeemon and Denny John and Jonas, {Jost B.} and Jacek J{\'o}{\'z}wiak and Rizwan Kalani and Amit Kandel and Amir Kasaeian and Kengne, {Andre P.} and Khader, {Yousef S.} and Khan, {Abdur R.} and Khang, {Young Ho} and Jagdish Khubchandani and Daniel Kim and Kim, {Yun J.} and Mika Kivimaki and Yoshihiro Kokubo and Dhaval Kolte and Kopec, {Jacek A.} and Soewarta Kosen and Michael Kravchenko and Rita Krishnamurthi and {Anil Kumar}, G. and Alessandra Lafranconi and Lavados, {Pablo M.} and Yirga Legesse and Yongmei Li and Xiaofeng Liang and Lo, {Warren D.} and Stefan Lorkowski and Lotufo, {Paulo A.} and Loy, {Clement T.} and Mackay, {Mark T.} and {Abd El Razek}, {Hassan Magdy} and Mahdi Mahdavi and Azeem Majeed and Reza Malekzadeh and Malta, {Deborah C.} and Mamun, {Abdullah A.} and Mantovani, {Lorenzo G.} and Martins, {Sheila C.O.} and Mate, {Kedar K.} and Mohsen Mazidi and Suresh Mehata and Toni Meier and Melaku, {Yohannes A.} and Walter Mendoza and Mensah, {George A.} and Atte Meretoja and Mezgebe, {Haftay B.} and Tomasz Miazgowski and Miller, {Ted R.} and Ibrahim, {Norlinah M.} and Shafiu Mohammed and Mokdad, {Ali H.} and Mahmood Moosazadeh and Moran, {Andrew E.} and Musa, {Kamarul I.} and Negoi, {Ruxandra I.} and Minh Nguyen and Nguyen, {Quyen L.} and Nguyen, {Trang H.} and Tran, {Tung T.} and Nguyen, {Thanh T.} and {Anggraini Ningrum}, {Dina Nur} and Bo Norrving and Noubiap, {Jean J.} and O'Donnell, {Martin J.} and Olagunju, {Andrew T.} and Onuma, {Oyere K.} and Owolabi, {Mayowa O.} and Mahboubeh Parsaeian and Patton, {George C.} and Michael Piradov and Pletcher, {Martin A.} and Farshad Pourmalek and V. Prakash and Mostafa Qorbani and Mahfuzar Rahman and Rahman, {Muhammad A.} and Rai, {Rajesh K.} and Annemarei Ranta and David Rawaf and Salman Rawaf and Renzaho, {Andre M.N.} and Robinson, {Stephen R.} and Ramesh Sahathevan and Amirhossein Sahebkar and Salomon, {Joshua A.} and Paola Santalucia and Santos, {Itamar S.} and Benn Sartorius and Schutte, {Aletta E.} and Sepanlou, {Sadaf G.} and Azadeh Shafieesabet and Shaikh, {Masood A.} and Morteza Shamsizadeh and Sheth, {Kevin N.} and Mekonnen Sisay and Shin, {Min Jeong} and Ivy Shiue and Silva, {Diego A.S.} and Eugene Sobngwi and Michael Soljak and Sorensen, {Reed J.D.} and Sposato, {Luciano A.} and Saverio Stranges and Suliankatchi, {Rizwan A.} and Rafael Tabar{\'e}s-Seisdedos and David Tanne and {Tat Nguyen}, Cuong and Thakur, {J. S.} and Thrift, {Amanda G.} and Tirschwell, {David L.} and Roman Topor-Madry and Tran, {Bach X.} and Nguyen, {Luong T.} and Thomas Truelsen and Nikolaos Tsilimparis and Stefanos Tyrovolas and Ukwaja, {Kingsley N.} and Uthman, {Olalekan A.} and Yuri Varakin and Tommi Vasankari and Narayanaswamy Venketasubramanian and Vlassov, {Vasiliy V.} and Wenzhi Wang and Andrea Werdecker and Wolfe, {Charles D.A.} and Gelin Xu and Yuichiro Yano and Naohiro Yonemoto and Chuanhua Yu and Zoubida Zaidi and {El Sayed Zaki}, Maysaa and Maigeng Zhou and Boback Ziaeian and Ben Zipkin and Theo Vos and Mohsen Naghavi and Murray, {Christopher J.L.}",

note = "Funding Information: Funded by the Bill and Melinda Gates Foundation. Funding Information: Supported by a grant from the Bill and Melinda Gates Foundation. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Publisher Copyright: {\textcopyright} 2018 Massachusetts Medical Society.",

year = "2018",

month = dec,

day = "20",

doi = "10.1056/NEJMoa1804492",

language = "English",

volume = "379",

pages = "2429--2437",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "25",

}

Roth, GA, Feigin, VL, Nguyen, G, Cercy, K, Johnson, CO, Alam, T, Parmar, PG, Abajobir, AA, Abate, KH, Abd-Allah, F, Abejie, AN, Abyu, GY, Ademi, Z, Agarwal, G, Ahmed, MB, Akinyemi, RO, Al-Raddadi, R, Aminde, LN, Amlie-Lefond, C, Ansari, H, Asayesh, H, Asgedom, SW, Atey, TM, Ayele, HT, Banach, M, Banerjee, A, Barac, A, Barker-Collo, SL, Bärnighausen, T, Barregard, L, Basu, S, Bedi, N, Behzadifar, M, Béjot, Y, Bennett, DA, Bensenor, IM, Berhe, DF, Boneya, DJ, Brainin, M, Campos-Nonato, IR, Caso, V, Castañeda-Orjuela, CA, Rivas, JC, Catalá-López, F, Christensen, H, Criqui, MH, Damasceno, A, Dandona, L, Dandona, R, Davletov, K, de Courten, B, deVeber, G, Dokova, K, Edessa, D, Endres, M, Faraon, EJA, Farvid, MS, Fischer, F, Foreman, K, Forouzanfar, MH, Gall, SL, Gebrehiwot, TT, Geleijnse, JM, Gillum, RF, Giroud, M, Goulart, AC, Gupta, R, Gupta, R, Hachinski, V, Hamadeh, RR, Hankey, GJ, Hareri, HA, Havmoeller, R, Hay, SI, Hegazy, MI, Hibstu, DT, James, SL, Jeemon, P, John, D, Jonas, JB, Jóźwiak, J, Kalani, R, Kandel, A, Kasaeian, A, Kengne, AP, Khader, YS, Khan, AR, Khang, YH, Khubchandani, J, Kim, D, Kim, YJ, Kivimaki, M, Kokubo, Y, Kolte, D, Kopec, JA, Kosen, S, Kravchenko, M, Krishnamurthi, R, Anil Kumar, G, Lafranconi, A, Lavados, PM, Legesse, Y, Li, Y, Liang, X, Lo, WD, Lorkowski, S, Lotufo, PA, Loy, CT, Mackay, MT, Abd El Razek, HM, Mahdavi, M, Majeed, A, Malekzadeh, R, Malta, DC, Mamun, AA, Mantovani, LG, Martins, SCO, Mate, KK, Mazidi, M, Mehata, S, Meier, T, Melaku, YA, Mendoza, W, Mensah, GA, Meretoja, A, Mezgebe, HB, Miazgowski, T, Miller, TR, Ibrahim, NM, Mohammed, S, Mokdad, AH, Moosazadeh, M, Moran, AE, Musa, KI, Negoi, RI, Nguyen, M, Nguyen, QL, Nguyen, TH, Tran, TT, Nguyen, TT, Anggraini Ningrum, DN, Norrving, B, Noubiap, JJ, O'Donnell, MJ, Olagunju, AT, Onuma, OK, Owolabi, MO, Parsaeian, M, Patton, GC, Piradov, M, Pletcher, MA, Pourmalek, F, Prakash, V, Qorbani, M, Rahman, M, Rahman, MA, Rai, RK, Ranta, A, Rawaf, D, Rawaf, S, Renzaho, AMN, Robinson, SR, Sahathevan, R, Sahebkar, A, Salomon, JA, Santalucia, P, Santos, IS, Sartorius, B, Schutte, AE, Sepanlou, SG, Shafieesabet, A, Shaikh, MA, Shamsizadeh, M, Sheth, KN, Sisay, M, Shin, MJ, Shiue, I, Silva, DAS, Sobngwi, E, Soljak, M, Sorensen, RJD, Sposato, LA, Stranges, S, Suliankatchi, RA, Tabarés-Seisdedos, R, Tanne, D, Tat Nguyen, C, Thakur, JS, Thrift, AG, Tirschwell, DL, Topor-Madry, R, Tran, BX, Nguyen, LT, Truelsen, T, Tsilimparis, N, Tyrovolas, S, Ukwaja, KN, Uthman, OA, Varakin, Y, Vasankari, T, Venketasubramanian, N, Vlassov, VV, Wang, W, Werdecker, A, Wolfe, CDA, Xu, G, Yano, Y, Yonemoto, N, Yu, C, Zaidi, Z, El Sayed Zaki, M, Zhou, M, Ziaeian, B, Zipkin, B, Vos, T, Naghavi, M & Murray, CJL 2018, 'Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016', New England Journal of Medicine, vol. 379, no. 25, pp. 2429-2437. https://doi.org/10.1056/NEJMoa1804492

TY - JOUR

T1 - Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

AU - Roth, Gregory A.

AU - Feigin, Valery L.

AU - Nguyen, Grant

AU - Cercy, Kelly

AU - Johnson, Catherine O.

AU - Alam, Tahiya

AU - Parmar, Priyakumari G.

AU - Abajobir, Amanuel A.

AU - Abate, Kalkidan H.

AU - Abd-Allah, Foad

AU - Abejie, Ayenew N.

AU - Abyu, Gebre Y.

AU - Ademi, Zanfina

AU - Agarwal, Gina

AU - Ahmed, Muktar B.

AU - Akinyemi, Rufus O.

AU - Al-Raddadi, Rajaa

AU - Aminde, Leopold N.

AU - Amlie-Lefond, Catherine

AU - Ansari, Hossein

AU - Asayesh, Hamid

AU - Asgedom, Solomon W.

AU - Atey, Tesfay M.

AU - Ayele, Henok T.

AU - Banach, Maciej

AU - Banerjee, Amitava

AU - Barac, Aleksandra

AU - Barker-Collo, Suzanne L.

AU - Bärnighausen, Till

AU - Barregard, Lars

AU - Basu, Sanjay

AU - Bedi, Neeraj

AU - Behzadifar, Masoud

AU - Béjot, Yannick

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhe, Derbew F.

AU - Boneya, Dube J.

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N1 - Funding Information: Funded by the Bill and Melinda Gates Foundation. Funding Information: Supported by a grant from the Bill and Melinda Gates Foundation. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Publisher Copyright: © 2018 Massachusetts Medical Society.

PY - 2018/12/20

Y1 - 2018/12/20

N2 - BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

AB - BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low- SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.

UR - http://www.scopus.com/inward/record.url?scp=85058877243&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1804492

DO - 10.1056/NEJMoa1804492

M3 - Journal article

C2 - 30575491

AN - SCOPUS:85058877243

SN - 0028-4793

VL - 379

SP - 2429

EP - 2437

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 25

ER -

Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016

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