BTN News: In a concerning new report, experts reveal that the global burden of stroke has surged dramatically between 1990 and 2021, highlighting the need for urgent global health interventions. The analysis, published in The Lancet Neurology and presented at the 2024 World Stroke Congress in Abu Dhabi, shows that while stroke is preventable and treatable, the worldwide incidence, disability, and death rates associated with strokes have risen substantially. This rapid increase is attributed to population growth, aging, and heightened exposure to preventable environmental and behavioral risk factors.
Stroke Cases Surge Worldwide: A Call for Action
The number of people experiencing strokes each year has increased by 70% since 1990, reaching 11.9 million new cases in 2021. Stroke-related deaths have climbed by 44%, now accounting for 7.3 million deaths annually, making stroke the third leading cause of death globally after heart disease and COVID-19. The research indicates that 93.8 million stroke survivors were living with the long-term effects of stroke by 2021, an 86% increase since 1990.
These statistics paint a worrying picture, particularly for low- and middle-income countries (LMICs), where more than 75% of stroke cases are concentrated. The data emphasizes the importance of addressing stroke as a growing public health crisis worldwide.
Understanding the Leading Risk Factors for Stroke
Several preventable risk factors have been linked to the rising incidence of stroke. From 1990 to 2021, strokes tied to high body mass index (BMI) soared by 88%, while those linked to high temperatures increased by 72%. Other significant contributors include elevated blood sugar (up 32%), poor diet (up 23%), low physical activity (up 11%), and high systolic blood pressure (up 7%).
Environmental factors, including air pollution and extreme weather, have also played a role in increasing stroke cases globally. High cholesterol (LDL), smoking, and air pollution in homes are among the top five contributors to stroke, underscoring the need for immediate action to mitigate these risks.
How Stroke Affects Global Health
Stroke has become one of the primary drivers of global health loss, measured in Years of Life Adjusted for Disability (AVAD). Between 1990 and 2021, the total number of healthy life years lost to stroke rose by 32%, from 121.4 million AVAD in 1990 to 160.5 million AVAD in 2021. This makes stroke the fourth leading cause of health loss globally, trailing only COVID-19, heart disease, and neonatal disorders.
The Global Burden of Disease (GBD) study provides the most comprehensive and up-to-date analysis of stroke’s impact on public health worldwide. By quantifying years lost to disability, illness, and early death, the GBD data offers crucial insights for healthcare planners, policymakers, and clinicians as they seek to mitigate the burden of stroke.
Declining Age-Standardized Stroke Rates: A Silver Lining
Despite the increase in absolute numbers, age-standardized data offers some hope. When adjusted for demographic changes like population aging, the age-standardized incidence of stroke has actually decreased by 22% since 1990. Likewise, age-standardized stroke prevalence dropped by 8%, deaths by 39%, and AVAD by 39%. These trends suggest that stroke prevention and treatment efforts have had a positive impact, though the overall burden continues to grow due to aging populations and environmental risk factors.
Key Findings from the Global Burden of Disease Study
- High blood pressure remains the leading risk factor for stroke globally.
- Air pollution ranks as the second most significant environmental risk, contributing heavily to stroke cases, particularly in low-income countries.
- Stroke risk tied to tobacco use and high cholesterol continues to drive the global stroke crisis, affecting millions each year.
- Sub-Saharan Africa, Eastern Europe, and Asia are regions experiencing disproportionately high stroke burdens.
- The research highlights the importance of population-wide preventive strategies, including air quality improvements, healthier diets, and more accessible healthcare.
Addressing the Global Stroke Crisis: Urgent Need for New Strategies
The current strategies to prevent strokes are falling short, according to Professor Valery L. Feigin, lead author of the study and a specialist from the University of Washington. “We need new and more effective stroke prevention strategies that can be implemented on a global scale,” Feigin said. He emphasized the importance of population-level health interventions, such as task-shifting—where medical duties are transferred to nurses and community health workers—and the wider use of mobile health technologies.
The findings of the 2023 Lancet Commission on Stroke Neurology echo this sentiment, advocating for accessible, evidence-based strategies aimed at high-risk populations. Such efforts could significantly reduce the stroke burden, particularly in LMICs where the crisis is most severe.
Progress in Reducing Key Risk Factors
While the overall burden of stroke has increased, some encouraging progress has been made in reducing risk factors linked to lifestyle choices and environmental conditions. Between 1990 and 2021:
- Stroke-related health loss due to processed meat consumption dropped by 40%.
- Strokes caused by diets low in vegetables decreased by 30%.
- The impact of air pollution (from particulate matter) on stroke was reduced by 20%.
- Stroke risk associated with tobacco use declined by 13%.
These improvements show that policies aimed at reducing exposure to these risk factors—such as clean air initiatives and anti-smoking legislation—are making a tangible difference.
The Road Ahead: Preventing Stroke in the 2020s and Beyond
The study’s authors emphasize that more effective global action is needed to reverse the rising tide of stroke cases. Governments and healthcare systems must adopt a multifaceted approach that includes:
- Expanding the role of technology, such as telehealth platforms, to improve stroke prevention and care.
- Implementing community-based prevention efforts, especially in regions where healthcare access is limited.
- Enhancing public health campaigns to raise awareness about modifiable risk factors like obesity, smoking, and poor diet.
Addressing these challenges head-on could dramatically reduce the global stroke burden in the coming decades and improve millions of lives.
Conclusion
The increasing global burden of stroke presents a serious public health challenge, especially for low- and middle-income countries. However, with focused preventive strategies, improved healthcare access, and innovative public health interventions, there is hope for reversing these trends. As highlighted by Professor Feigin, the time to act is now—before the global stroke crisis worsens further.
