Cited by 3,912Acute Ischemic Stroke ManagementCardiovascular Health and Risk FactorsGlobal Health and Epidemiology

The DOI matches its Crossref record; 52 of the 54 references it cites were found in a registry or an index; 9 of the 48 sources its claims cite were checked for support.

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

Open access

Abstract

Summary Background Although stroke is the second leading cause of death worldwide, no comprehensive and comparable assessment of incidence, prevalence, mortality, disability, and epidemiological trends has been estimated for most regions. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of stroke during 1990–2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and WHO regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR), based on disease-specific, pre-specified associations between incidence, prevalence, and mortality, to calculate regional and country-specific estimates of stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) lost by age group (<75 years, ≥75 years, and in total) and country income level (high-income, and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). From 1990 to 2010, the age-standardised incidence of stroke significantly decreased by 12% (95% CI 6–17) in high-income countries, and increased by 12% (–3 to 22) in low-income and middle-income countries, albeit non-significantly. Mortality rates decreased significantly in both high income (37%, 31–41) and low-income and middle-income countries (20%, 15–30). In 2010, the absolute numbers of people with first stroke (16·9 million), stroke survivors (33 million), stroke-related deaths (5·9 million), and DALYs lost (102 million) were high and had significantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68·6% incident strokes, 52·2% prevalent strokes, 70·9% stroke deaths, and 77·7% DALYs lost) in low-income and middle-income countries. In 2010, 5·2 million (31%) strokes were in children (aged <20 years old) and young and middle-aged adults (20–64 years), to which children and young and middle-aged adults from low-income and middle-income countries contributed almost 74 000 (89%) and 4·0 million (78%), respectively, of the burden. Additionally, we noted significant geographical differences of between three and ten times in stroke burden between GBD regions and countries. More than 62% of new strokes, 69·8% of prevalent strokes, 45·5% of deaths from stroke, and 71·7% of DALYs lost because of stroke were in people younger than 75 years. Interpretation Although age-standardised rates of stroke mortality have decreased worldwide in the past two decades, 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. Further study is needed to improve understanding of stroke determinants and burden worldwide, and to establish causes of disparities and changes in trends in stroke burden between countries of different income levels. Funding Bill & Melinda Gates Foundation.

Overview

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(13)61953-4

Cites

52 of 52 references verified0 citation errors · 0 not checkable

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Verification

Claims the paper makes

91 Own result · 19 Not checked yet · 11 Own method · 10 Own interpretation · 4 No basis given · 3 Supported · 2 Partly supported · accuracy not yet measured

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Show all 72 claims

  • Probably not a substantial claim. 28
  • It may state two separate claims as one. 39
  • The quote only partly states this claim. 5
68 of 68
  • The paper relies on this without support.

    No comprehensive and comparable assessment of stroke incidence, prevalence, mortality, disability burden, and recent epidemiological trends has been estimated for most world regions.

    “However, no comprehensive and comparable assessment of stroke incidence, prevalence, mortality, disability burden (as measured by DALYs lost), and recent epidemiologic trends has been estimated for most world regions.”
  • The authors state this as an assumption.

    The direction of effect of selected covariates on stroke mortality is plausible based on existing scientific literature.

    “We selected a set of relevant covariates and assumed a plausible direction of effect on the basis of existing scientific literature (appendix).”
  • The authors state this as an assumption.

    A hierarchy of risk exists that would be retained in the model.

    “We assumed that a hierarchy of risk existed that would be retained in the model.”
  • The authors state this as an assumption.

    Comorbid diseases have independent probabilities.

    “assuming independent probabilities of comorbid diseases (eg, stroke plus diabetes).”
  • The authors state this as an assumption.

    Disability is the same for haemorrhagic and ischaemic stroke during the hyperacute phase (1-3 days after event).

    “We assumed the same disability for haemorrhagic and ischaemic stroke during the hyperacute phase (ie, 1–3 days after the event)”
  • The authors state this as an assumption.

    The distribution of severity is similar based on GBD sequela definition and Rankin Scale categories.

    “We assumed a similar distribution of severity on the basis of the GBD sequela definition and Rankin Scale categories.”
  • The authors state this as an assumption.

    Trends in stroke incidence, mortality, and DALYs will continue as observed.

    “If these trends in stroke incidence, mortality, and DALYs continue”
  • The authors state this as an assumption.

    Trends in smoking and other stroke risk factors in the developing world will continue unchecked.

    “if these trends continue and are left unchecked”
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Metadata

Authors
Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., Sacco, R. L., Anderson, L., Truelsen, T., O'Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C. M. M., Wang, W., Shinohara, Y., Witt, E., Ezzati, M., Naghavi, M., & Murray, C.
Affiliations
  • Auckland University of Technology (NZ)
  • University of Washington (US)
  • National Institutes of Health (US)
  • National Health Service (GB)
  • University of Oxford (GB)
  • Columbia University Irving Medical Center (US)
  • University of Miami (US)
  • Washington State Institute for Public Policy (US)
  • Herlev Hospital (DK)
  • Ollscoil na Gaillimhe – University of Galway (IE)
  • University of Auckland (NZ)
  • Capital Medical University (CN)
  • Tachikawa Hospital (JP)
  • Imperial College London (GB)
Corresponding author
Feigin, Valery L
Venue
The Lancet
Publisher
Elsevier BV
Published
2014-01
Volume
383
Issue
9913
Pages
245-255
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2155477484
Cited by
3,899
References
54
Citations by year
2026: 114 · 2025: 184 · 2024: 245 · 2023: 261 · 2022: 302 · 2021: 364 · 2020: 416 · 2019: 424 · 2018: 400 · 2017: 411 · 2016: 346 · 2015: 293 · 2014: 126
FWCI
30.49
Type
journal article
Language
en
Update notices
erratum (2014-01-18)
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • National University of Singapore (submittedVersion)
Funders
  • University of Miami
  • National Heart, Lung, and Blood Institute (K08HL089675)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
Keywords
stroke, global burden of disease, stroke incidence, stroke prevalence, stroke mortality, disability-adjusted life years, stroke survivors, epidemiological trends, high-income countries, low- and middle-income countries, regional variation, age-standardized rates, Global Burden of Disease Study 2010, disability burden
MeSH terms
Age Factors, Developing Countries, Humans, Mortality, Global Health, Cost of Illness, Developed Countries, Quality-Adjusted Life Years, Stroke

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