Background

Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021.

Methods

We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.

Findings

In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]).

Interpretation

Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

---

1990-2021 年全球、区域和国家中风负担及其风险因素：2021 年全球疾病负担研究的系统分析

 背景

全球、区域和国家层面对卒中负担和归因风险及其趋势的最新估计对于循证医疗保健、预防和资源分配规划至关重要。我们旨在提供 1990 年至 2021 年期间的此类估计。

 方法

我们估计了 1990 年至 2021 年期间 204 个国家和地区的总体卒中、缺血性卒中、脑出血和蛛网膜下腔出血的发病率、患病率、死亡率、残疾调整生命年 （disability-adjusted lifeyear， DALY） 计数和年龄标准化发病率。我们还计算了全球和区域层面（21 个 GBD 地区和社会人口指数 [SDI] 五分位数）归因于 23 个风险因素和 6 个风险集群 （空气污染、吸烟、行为、饮食、环境和代谢风险） 的中风负担，使用标准 GBD 方法。每个单独未来估计的 95% 不确定性区间 （UI） 来自通过多阶段计算管道传播 500 次抽奖生成的第 2·5 个和第 97·5 个百分位数的分布。

 发现

2021 年，中风是继缺血性心脏病和 COVID-19 之后的第三大最常见的 GBD 3 级死亡原因（7·30 万 [95% UI 6·6-7·8] 死亡;占所有死亡人数的 10·7% [9·8-11·3]），也是 DALY 的第四大最常见原因（1.605 亿 [147·8–171·6] 残疾调整生命年;占所有 DALY 的 5·6% [5·0–6·1]）。2021 年，有 93·800 万 （89·0–99·3） 的普遍中风和 11·90 万 （10·7–13·2） 的中风发生率。我们发现 GBD 地区、国家或地区和 SDI 在卒中负担和危险因素方面存在差异，并且从 2015 年开始发病率下降停滞不前，甚至在东南亚、东亚和大洋洲、SDI 较低的国家和 70 岁以下的人群中风发病率、死亡率、患病率和 DALY 率有所增加。在全球范围内，缺血性中风占 65·3% （62·4–67·7），脑出血占 28·8% （28·3–28·8），蛛网膜下腔出血占中风发病的 5·8% （5·7–6·0）。由于高 BMI （88·2% [53·4–117·7]）、高环境温度 （72·4% [51·1 至 179·5]）、高空腹血糖 （32·1% [26·7–38·1]）、高含糖饮料饮食 （23·4% [12·7–35·7]）、低体力活动 （11·3% [1·8–34·9]）、 高收缩压 （6·7% [2·5–11·6]）、铅暴露 （6·5% [4·5–11·2]） 和 omega-6 多不饱和脂肪酸含量低 （5·3% [0·5–10·5]） 饮食。

 解释

从 1990 年到 2021 年，中风负担有所增加，几个风险因素的贡献也有所增加。所有国家都需要紧急实施有效、可及和负担得起的措施来改善卒中监测、预防（重点是血压、生活方式和环境因素）、急症护理和康复，以减轻卒中负担。

 资金

比尔和梅琳达·盖茨基金会。