Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021.
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Martinez Ramón, Muñoz-Venturelli Paula, Ordunez Pedro, Fregni Felipe, Abanto Carlos, Alet Matias, Alvarez Tony Fabián, Amaya Pablo, Ameriso Sebastian, Arauz Antonio, Barboza Miguel A, Bayona Hernán, Bernabé-Ortiz Antonio, Calleja Juan, Cano-Nigenda Vanessa, Carbonera Leonardo Augusto, Carrillo-Larco Rodrigo M, Corredor Angel, de Souza Ana Cláudia, Jimenez Claudio, Lanas Fernando, Martins Sheila, Navia Victor, Novarro-Escudero Nelson, Olavarría Verónica, Ovbiagele Bruce, Pacheco-Barrios Kevin, Pontes-Neto Octavio, Pujol Virginia, Rabinstein Alejandro, Rosales Julieta, Rosende Andrés, Sampaio Silva Gisele, Saposnik Gustavo, Sen Souvik, Testai Fernando D, Urrutia Victor, Anderson Craig S, Lavados Pablo M
Аннотация
METHODS: Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends.
FINDINGS: In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends.
INTERPRETATION: Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend.
FUNDING: There was no funding source for this study.