Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010

May combine two claims.

Stroke mortality increased in sub-Saharan Africa, south Asia, and central and Latin America.

“Mortality increased in sub-Saharan Africa, south Asia, and central and Latin America, but decreased in high-income North America, western and central Europe, north Africa and the Middle East, Australasia, and high-income Asia Pacific”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, there were an estimated 16.9 million incident strokes worldwide.

“an estimated 16·9 million cases of incident stroke took place worldwide”

• Also stated in: § Findings · plain

  “the absolute numbers of people with first stroke (16·9 million)”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

In 2010, country-level DALYs lost ranged from 398 per 100,000 in Australia to 5227 in Afghanistan.

“DALYs lost, ranging from 398 (Australia) to 5227 (Afghanistan) per 100 000 people”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 22% of all stroke deaths were in adults aged 20-64.

“0·7% and 22% of all stroke deaths”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 69% of incident strokes occurred in low-income and middle-income countries.

“(69% in low-income and middle-income countries)”

The quote only partly states this claim.

In 2010, age-standardised stroke incidence rates in low-income and middle-income countries exceeded those in high-income countries by 23%.

“Presently, age-standardised rates of stroke incidence in low-income and middle-income countries exceed those in high-income countries by 23%”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, there were an estimated 33.0 million prevalent stroke cases worldwide.

“33·0 million prevalent stroke cases”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 28% of DALYs lost occurred in people aged 75 years and older.

“28% of DALYs lost (46% in high-income countries and 23% in low-income and middle-income countries) were in people aged 75 years and older”

May combine two claims.

Stroke mortality decreased in high-income North America, western and central Europe, north Africa and the Middle East, Australasia, and high-income Asia Pacific.

“but decreased in high-income North America, western and central Europe, north Africa and the Middle East, Australasia, and high-income Asia Pacific”

May combine two claims.

In low-income and middle-income countries, age-standardised incidence and prevalence increased almost equally (9-10%) in younger and older people, but the increases were not significant.

“In low-income and middle-income countries, age-standardised incidence and prevalence increased almost equally (9–10%) in younger and older people, but the increases were not significant”

May combine two claims.

The largest reductions in DALYs lost occurred in west and central sub-Saharan Africa, eastern Europe, and central, south, and southeast Asia.

“The most marked reductions in DALYs lost were in west and central sub-Saharan Africa; eastern Europe; and central, south, and southeast Asia (figure 4 and appendix).”

May combine two claims.

In high-income countries, DALYs lost fell by 36% in people younger than 75 and by 63% in older people.

“whereas DALYs lost fell by 36% in people younger than 75 years and by 63% in older people”

• AssumptionThe authors state this as an assumption: Comorbid diseases have independent probabilities.
• AssumptionThe authors state this as an assumption: Disability is the same for haemorrhagic and ischaemic stroke during the hyperacute phase (1-3 days after event).
• AssumptionThe authors state this as an assumption: The distribution of severity is similar based on GBD sequela definition and Rankin Scale categories.

May combine two claims.

In low-income and middle-income countries, significant reductions occurred in age-standardised stroke mortality (24%), DALYs lost (24%), and mortality-to-incidence ratios (32%) in people younger than 75 compared with older people (16%, 17%, and 23% respectively).

“Most striking were significant reductions in rates of age-standardised stroke mortality (24%), DALYs lost (24%), and mortality-to-incidence ratios (32%) in people younger than 75 years compared with older people (16%, 17%, and 23% respectively”

• AssumptionThe authors state this as an assumption: The direction of effect of selected covariates on stroke mortality is plausible based on existing scientific literature.
• AssumptionThe authors state this as an assumption: A hierarchy of risk exists that would be retained in the model.
• AssumptionThe authors state this as an assumption: Comorbid diseases have independent probabilities.
• AssumptionThe authors state this as an assumption: Disability is the same for haemorrhagic and ischaemic stroke during the hyperacute phase (1-3 days after event).
• AssumptionThe authors state this as an assumption: The distribution of severity is similar based on GBD sequela definition and Rankin Scale categories.

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 30% of prevalent strokes occurred in people aged 75 years and older.

“30% of prevalent strokes (40% in high-income countries and 22% in low-income and middle-income countries)”

May combine two claims.

Of 16,558 potentially eligible studies, 119 articles were selected for final analysis, including 58 from high-income countries and 61 from low-income and middle-income countries.

“Of 16 558 potentially eligible studies undertaken in 1990–2010, we selected 119 articles for final analysis: 58 from high-income countries and 61 from low-income and middle-income countries.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 78% of DALYs lost were in low-income and middle-income countries.

“(78% in low-income and middle-income countries; table 1)”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, there were an estimated 5.9 million stroke deaths worldwide.

“5·9 million stroke deaths”

May combine two claims.

Stroke prevalence increased by 8.5% (-13 to 34) in low-income and middle-income countries, but the increase was not significant.

“the 8·5% (−13 to 34) increase in low-income and middle-income countries was not significant.”

May combine two claims.

In 2010, the mortality-to-incidence ratio was 0.32 in high-income countries and 0.36 in low-income and middle-income countries.

“(0·32 in high-income countries and 0·36 in low-income and middle-income countries; table 1)”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 71% of stroke deaths occurred in low-income and middle-income countries.

“(71% in low-income and middle-income countries)”

May combine two claims.

The most striking increases in number of stroke survivors (113%), DALYs lost (31%), and stroke-related deaths (36%) occurred in people aged 75 years and older.

“The most striking increases in the number of stroke survivors (113%), DALYs lost (31%), and stroke-related deaths (36%) were in people aged 75 years and older”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, country-level stroke prevalence ranged from 82 survivors per 100,000 in Burundi to 1187 in Canada.

“prevalence, ranging from 82 stroke survivors (Burundi) to 1187 survivors (Canada) per 100 000 people”

May combine two claims.

From 1990 to 2010, age-standardised stroke incidence increased by 12% (-3 to 22) in low-income and middle-income countries, but the increase was not significant.

“and a 12% [−3 to 22] non-significant increase in low-income and middle-income countries”

May combine two claims.

Stroke incidence increased in sub-Saharan Africa (central, east, southern, and west), the Middle East, southeast Asia, central and Latin America, and south and east Asia.

“By GBD regions, increases were shown in stroke incidence in sub-Saharan Africa (central, east, southern, and west), the Middle East, southeast Asia, central and Latin America, and south and east Asia, but incidence decreased in high-income Asia Pacific”

The quote only partly states this claim.

Of the strokes in people younger than 65 in 2010, children in low-income and middle-income countries contributed almost 74,000 (89%).

“to which children and young to middle-age adults in low-income and middle-income countries contributed almost 74 000 (89%)”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

In 2010, there were an estimated 102.2 million DALYs lost worldwide.

“102·2 million DALYs lost”

The quote only partly states this claim.

Mortality-to-incidence ratio decreased significantly by 23% (14-29) in high-income countries.

“mortality-to-incidence ratio (23% [14–29]”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, 52% of prevalent stroke cases were in low-income and middle-income countries.

“(52% in low-income and middle-income countries)”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2010, country-level mortality-to-incidence ratios ranged from 0.11 in Iran to 1.35 in Afghanistan.

“and in mortality-to-incidence ratios, ranging from 0·11 (Iran) to 1·35 (Afghanistan).”

May combine two claims.

In the past two decades there was a trend towards incident stroke occurring later in life, probably because of an ageing population.

“Although in the past two decades there was a trend towards occurrence of incident stroke later in life, probably because of an ageing population,35”

• cites [35] Cairncross, 2007, Economics: age, health and wealth, Nature sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Even low-income and middle-income regions with relatively low stroke incidence and prevalence, such as sub-Saharan Africa, have high stroke mortality rates and a low rate of reduction in DALYs lost.

“Even low-income and middle-income regions with a relatively low stroke incidence and prevalence, such as sub-Saharan Africa, have high stroke mortality rates and a low rate of reduction in DALYs lost.”

May combine two claims.

Stroke mortality decreased in low-income and middle-income countries, but the decrease was not significant.

“our findings of the decrease in mortality in low-income and middle-income countries, although not significant, were unexpected.”

May combine two claims.

Stroke mortality rates and mortality-to-incidence ratios decreased over the past two decades.

“Our findings show that although stroke mortality rates and mortality-to-incidence ratios have decreased in the past two decades”

May combine two claims.

In low-income and middle-income countries, stroke incidence has increased, and mortality-to-incidence ratios and DALYs lost are higher than in high-income countries.

“For example, in these countries, stroke incidence has increased, and mortality-to-incidence ratios and DALYs lost are higher than in high-income countries.”

Probably not a substantial claim: may not pass S3 (load-bearing).

More than 83,000 children and youths aged 20 years and younger are affected by stroke annually.

“and more than 83 000 children and youths aged 20 years and younger are affected by stroke annually.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Worldwide in 2010, roughly 10% of deaths and about 4% of DALYs were due to stroke.

“Worldwide in 2010, roughly 10% of the 52 769 700 deaths1 and about 4% of the 2 490 385 000 DALYs2 were due to stroke.”

• cites [1] Lozano, 2012, Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [2] Murray, 2012, Disability-adjusted life-years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This study is the first to show that age-specific stroke burden is significantly greater in low-income and middle-income countries than in high-income countries, while age-specific stroke prevalence is significantly greater in high-income countries.

“Our study is the first to show that the age-specific burden of stroke in low-income and middle-income countries is significantly greater than that in high-income countries, whereas the age-specific prevalence of stroke is significantly greater in high-income countries.”

May combine two claims.

The proportion of young people aged under 20 years and young and middle-aged adults aged 20-64 years affected by stroke increased.

“the pro portion of young people (aged <20 years) and young and middle-aged adults (20–64 years) affected by stroke increased.”

May combine two claims.

The absolute global burden of stroke-people affected each year, survivors, related deaths, and DALYs lost-is large and increasing.

“the global burden of stroke in terms of the absolute number of people affected every year, stroke survivors, related deaths, and DALYs lost are great and increasing”

Probably not a substantial claim: may not pass S3 (load-bearing).

Stroke was the second leading cause of death worldwide in 2010 according to GBD 2010.

“Estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2010) ranked stroke as the second most common cause of death1”

• cites [1] Lozano, 2012, Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Stroke was the third leading cause of DALYs worldwide in 2010 according to GBD 2010.

“and the third most common cause of disability-adjusted life-years (DALYs)2 worldwide in 2010.”

• cites [2] Murray, 2012, Disability-adjusted life-years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

For low-income and middle-income countries, less rigorous case ascertainment was permitted when no other relevant data were available.

“We allowed less rigorous case ascertainment for studies from low-income and middle-income countries in which no other relevant data were otherwise available”

• cites [5] Bennett, 2012, Methodology of the global and regional burden of stroke study, Neuroepidemiology sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The same prior review found a 42% decrease in stroke incidence in high-income countries over the past four decades.

“by contrast with high-income countries where a 42% decrease in incidence has taken place in the past four decades.”

• cites [3] Feigin, 2009, Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review, Lancet Neurol sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

For high-income countries, incidence studies were required to have complete ascertainment of stroke cases with multiple overlapping sources.

“Incidence studies from high-income countries had to include complete ascertainment of stroke cases (ie, admitted or not admitted to hospital, fatal and non-fatal) with several overlapping sources of information”

• cites [7] Feigin, 2004, How to study stroke incidence, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

High methodological quality studies (rating 4-5) made up 55 (95%) of high-income country studies and 14 (23%) of low-income and middle-income country studies.

“Studies of a high methodological quality (quality rating 4–5) constituted 55 (95%) of the studies in high-income countries and 14 (23%) of those in low-income and middle-income countries.”

May combine two claims.

The analysis included only studies that used WHO's stroke definition, reported case ascertainment methods, distinguished first-ever from recurrent stroke, and reported age-specific epidemiological parameter and population denominator.

“we included only studies that used WHO’s definition of stroke,6 that reported methods for ascertainment stroke cases, that distinguished between first-ever and recurrent stroke (only incident strokes were included in these analyses), and that reported an age-specific epidemiological parameter of interest and the population denominator”

• cites [6] Aho, 1980, Cerebrovascular disease in the community: results of a WHO collaborative study, Bull World Health OrganNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A prior systematic review of population-based stroke incidence studies from 28 countries found increasing incidence in low-income and middle-income countries.

“A previous systematic review3 of population-based studies of stroke incidence from 28 countries showed that incidence is increasing in low-income and middle-income countries”

• cites [3] Feigin, 2009, Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review, Lancet Neurol sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The sponsor had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

“The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.”

May combine two claims.

GBD 2010 developed statistical methods to address incomplete epidemiological data and produce comparable estimates of global burden for 291 diseases and injuries across 21 world regions.

“The GBD 2010 investigators developed statistical methods4 to address incomplete epidemiological data and provide the most complete and com parable estimates of the global burden of 291 diseases and injuries in all countries grouped into 21 world regions”

• cites [4] Murray, 2012, GBD 2010: design, definitions, and metrics, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke are great and increasing.

“the absolute number of people who have a stroke every year, stroke survivors, related deaths, and the overall global burden of stroke (DALYs lost) are great and increasing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

GBD 2010 estimates showed that ischaemic heart disease and stroke were the two greatest causes of death between 1990 and 2010.

“Although the estimates from the GBD 2010 Study showed that ischaemic heart disease and stroke were the two greatest causes of death between 1990 and 2010,1,8”

• cites [1] Lozano, 2012, Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [8] Wang, 2012, Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The study probably underestimated stroke burden by excluding silent strokes and vascular dementia from the case definition and by not including accelerated long-term cognitive functional decline in disability estimation.

“There fore, we probably underestimated the burden of stroke by not including so-called silent strokes and vascular dementia in the case definition nor the effect of accelerated long-term cognitive functional decline in our estimation of disability.”

May combine two claims.

Because of the worldwide diabetes epidemic and increasing prevalence of other cardiovascular risk factors in young adults and overall, especially in low-income and middle-income countries, the shift in stroke burden towards younger populations is likely to continue globally unless effective preventive strategies are urgently implemented.

“In view of the worldwide epidemic of diabetes38 and increasing prevalence of other cardiovascular risk factors in young adults39,40 and overall,41–45 especially in low-income and middle-income countries, the shift in stroke burden towards younger populations is likely to continue globally unless effective preventive strategies are urgently implemented.”

• cites [38] Danaei, 2011, National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [39] 2012, Challenging age—old ideas about stroke, Lancet NeurolNot checked yet

  Not checked in the free run.

• cites [40] de los Rios, 2012, Trends in substance abuse preceding stroke among young adults: a population-based study, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [41] Danaei, 2011, National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [42] Farzadfar, 2011, National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [43] Finucane, 2011, National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [44] 2011, An epidemic of risk factors for cardiovascular disease, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [45] Anand, 2011, Stemming the global tsunami of cardiovascular disease, Lancet sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The paper did not find a strong parallel between changes in stroke incidence and mortality, suggesting that factors contributing to stroke incidence and mortality or their changes over time might differ.

“As in a previous study30 we did not note a strong parallel between changes in stroke incidence and mortality, suggesting that factors contributing to stroke incidence and mortality or their changes (including level of exposure to those factors) over time might be different.31”

• cites [30] Stringhini, 2012, Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the African region, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [31] Truelsen, 2003, Trends in stroke and coronary heart disease in the WHO MONICA Project, Stroke sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This limitation should not have a marked effect on the estimates because standard methodological criteria for study selection were applied across the 20-year period and the quality of data was believed consistent for included studies.

“However, this limitation should not have a marked effect on our estimates because we applied standard methodological criteria for selection of studies across the 20 year study period and believe that the quality of data was consistent for included studies.”

May combine two claims.

The prevalence of smoking and other risk factors for stroke is increasing in the developing world.

“The increasing prevalence of smoking20 and other risk factors21 for stroke in the developing world is particularly alarming”

• cites [20] 2013Not checked yet

  Not checked in the free run.

• cites [21] Lim, 2012, A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A worrisome trend towards increasing stroke incidence in young adults has been reported for some countries.

“A worrisome trend towards increasing stroke incidence in young adults has been reported for some countries.36,37”

• cites [36] Kissela, 2012, Age at stroke: temporal trends in stroke incidence in a large, biracial population, Neurology sourceNot checked yet

  Not checked in the free run.

• cites [37] Medin, 2004, Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register, Stroke sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Together with increased mortality-to-incidence ratios in low-income and middle-income countries, the inverse prevalence-mortality association suggests that differences in acute stroke management are the likely explanation for prevalence differences, with less adequate management linked to greater case fatality and lower prevalence.

“Together with increased mortality-to-incidence ratios in low-income and middle-income countries, this finding suggests differences in the management of acute stroke as the likely explanation of differences in stroke prevalence, with less adequate stroke management being associated with a greater case fatality and subsequent lower levels of stroke prevalence.”

May combine two claims.

Together with a significant increase in stroke incidence in young and middle-aged adults, these findings suggest that stroke should no longer be regarded as a disease of old age.

“In addition to a significant increase in the incidence of stroke in young and middle-aged adults, these findings suggest that stroke should no longer be regarded as a disease of old age.”

May combine two claims.

Difficulty in access to health care and restricted resources for acute stroke treatment, rehabilitation, and secondary prevention are likely to account for higher stroke mortality, mortality-to-incidence ratios, and DALYs lost, and lower stroke prevalence in low-income and middle-income countries than in high-income countries.

“Difficulty in access to health care, and restricted resources in terms of adequate acute stroke treatment, rehabilitation, and secondary stroke prevention (eg, anticoagulation for patients with ischaemic stroke with atrial fibrillation) are likely to account for higher stroke mortality, mortality-to-incidence ratios, and DALYs lost, and lower stroke prevalence in low-income and middle-income coun”

• cites [19] Johnston, 2009, Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling, Lancet Neurol sourceNot checked yet

  Not checked in the free run.

• cites [34] Norrving, 2013, The global burden of stroke and need for a continuum of care, NeurologyNot checked yet

  Not checked in the free run.

May combine two claims.

This study was comprehensive in global coverage, based on the largest stroke epidemiological dataset to date, and was the first to provide systematic regional and country-specific estimates of stroke burden.

“This study was comprehensive in its global coverage, is based on the largest stroke epidemiological dataset to date, and is the first to provide systematic regional and country-specific estimates of stroke burden”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Wide geographical variations in stroke mortality rates, with significantly greater age-adjusted mortality and DALYs lost in low-income and middle-income countries than in high-income countries, have been reported elsewhere.

“Wide geographical variations in rates of stroke mortality,19,32,33 with significantly greater rates of age-adjusted mortality and DALYs lost in low-income and middle-income countries than in high-income countries,19 have also been reported elsewhere.”

• cites [19] Johnston, 2009, Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling, Lancet Neurol sourceNot checked yet

  Not checked in the free run.

• cites [32] Sarti, 2000, International trends in mortality from stroke, 1968 to 1994, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [33] Sarti, 2003, Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? Results from the WHO MONICA Project, Stroke sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The possibility of errors in calculations of stroke disability weights cannot be excluded.

“Although we cannot exclude the possibility of errors in calculations of stroke disability weights”

May combine two claims.

Sensitivity analyses for incomplete and poor-quality data and for settings with no data gave similar results, showing robustness of the stroke mortality estimates.

“The sensitivity analyses we undertook to assess the effects of incomplete and poor quality data , and for settings where no data were available, gave similar results, thus showing the robustness of estimates of stroke mortality.”

May combine two claims.

If current trends in stroke incidence, mortality, and DALYs continue, by 2030 there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally.

“If these trends in stroke incidence, mortality, and DALYs continue, by 2030 there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally.”

• AssumptionThe authors state this as an assumption: Trends in stroke incidence, mortality, and DALYs will continue as observed.

May combine two claims.

The high correlation of disability weights across settings suggests a broadly shared set of common values for health losses due to stroke, increasing confidence in the reliability of the disability weight calculations.

“the high correlation of the weights across settings suggests that a broadly shared set of common values exists for health losses due to stroke, thus increasing our confidence in the reliability of our calculations of disability weights.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The reduction in stroke mortality in high-income countries is not surprising because it has been consistently reported in most countries of this income level.

“Although the reduction in stroke mortality in high-income countries is not surprising because it has been consistently reported in most countries of this income level,25–28”

• cites [25] Vaartjes, 2013, Remarkable decline in ischemic stroke mortality is not matched by changes in incidence, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [26] Gillum, 2011, Ethnic and geographic variation in stroke mortality trends, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [27] Kunst, 2011, The decline in stroke mortality: exploration of future trends in 7 western European countries, Stroke sourceNot checked yet

  Not checked in the free run.

• cites [28] Redon, 2011, Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure, Eur Heart J sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The paper's results reinforce earlier conclusions that stroke burden is growing globally and especially in low-income and middle-income countries.

“Therefore, our results reinforce the conclusions of the 1990, 2001, and GBD 2010 studies about the growing burden of stroke globally and in low-income and middle-income countries in particular (panel).”