Stroke mortality is projected to increase to 9.7 million deaths by 2050, according to a report published by the World Stroke Organization’s Neurology Commission on Stroke and published online Oct. 9 in The Lancet Neurology. .
Noting that the incidence of stroke is increasing in young and middle-aged people around the world, Dr. Valery L. Feigin, of Auckland University of Technology in New Zealand, and colleagues predicted the stroke burden of 2020 to 2050.
The authors note that stroke mortality is projected to increase by 50 percent , from 6.6 to 9.7 million from 2020 to 2050, and disability-adjusted life years to increase from 144.8 to 189, 3 million during the same period. Based on this evaluation, the authors developed recommendations in the four pillars of the stroke quadrilateral : surveillance, prevention, intensive care, and rehabilitation .
Reducing the global burden of stroke is urgently needed by implementing primary and secondary stroke prevention strategies and evidence-based intensive care and rehabilitation services. To facilitate this goal, measures include establishing a framework to monitor and evaluate the burden of stroke and stroke services; implementation of strategies for people at increased risk of cerebrovascular disease; planning and delivery of acute stroke care services; promotion of interdisciplinary stroke care services; and creating a stroke advocacy and implementation ecosystem involving all relevant stakeholders.
"If this Commission’s recommendations are implemented, the burden of stroke will be substantially reduced worldwide by 2031 and beyond," the authors write.
Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization – Lancet Neurology Commission
Executive Summary
Stroke is the second leading cause of death worldwide. The burden of disability after stroke is also large and is increasing at a faster rate in low- and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (i.e., <55 years) globally. If these trends continue, the Sustainable Development Goal (reducing the burden of stroke as part of the overall goal of reducing the burden of non-communicable diseases by one-third by 2030) will not be met.
At this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%: from 6.6 million (95% uncertainty interval [UI]: 6.0 million to 7 .1 million) in 2020, to 9.7 million (8.0 million-11.6 million) in 2050, and disability-adjusted life years (DALYs) increased over the same period from 144.8 million (133.9 million-156.9 million) in 2020, to 189.3 million (161.8 million-224.9 million) in 2050. These projections led us to carry out an analysis of the situation in the four pillars of the quadrilateral of stroke: surveillance, prevention, acute care and rehabilitation. We have also identified the barriers and facilitators to achieving these four pillars.
Based on our assessment, we have identified and prioritized several recommendations. For each of the four pillars ( surveillance, prevention, intensive care and rehabilitation ), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (i.e., treatment and rehabilitation ) and indirect (considering loss of productivity) costs of stroke globally exceed $891 billion annually.
The pragmatic solutions we propose for urgent implementation should help mitigate these losses, reduce the global burden of stroke and contribute to the achievement of the Sustainable Development Goal, the WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (2022-2031) and the WHO Global Action Plan for the prevention and control of non-communicable diseases.
Reducing the global burden of stroke, particularly in low- and middle-income countries, is urgently needed through implementation of primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services.
Measures to facilitate this goal include: establishing a framework to monitor and evaluate the burden of stroke (and its risk factors) and stroke services nationally; the implementation of integrated prevention strategies at the population and individual level for people at increased risk of cerebrovascular disease, with emphasis on early detection and control of high blood pressure; planning and delivery of acute stroke care services, including establishing stroke units with access to reperfusion therapies for ischemic stroke and workforce training and capacity development (and monitoring quality indicators for these services at the national, regional and global level); promoting interdisciplinary stroke care services, caregiver training, and capacity building for community health workers and other health care providers working in stroke rehabilitation; and creating a stroke advocacy and implementation ecosystem that includes all relevant communities, organizations and stakeholders.
Key messages
• Stroke is the second leading cause of death, the third leading cause of disability and one of the leading causes of dementia worldwide. The age-standardized incidence of stroke in younger people (i.e., <55 years) is increasing in both high-income and low- and middle-income countries. The absolute number of people affected by stroke (i.e., dying or becoming disabled from a stroke) has almost doubled over the past three decades, with more than 86% of the stroke burden occurring in developing countries. low and middle income. Our projections show that the global burden of stroke (i.e., deaths and disability-adjusted life years) will continue to increase, with widening gaps between high-income and poorer countries.
• Multiple factors contribute to the high burden of stroke in low- and middle-income countries, including undetected and uncontrolled hypertension, lack of high-quality and easily accessible health services, insufficient attention and investment in prevention , air pollution, population growth, unhealthy lifestyles (e.g., poor diet, smoking, sedentary lifestyle, obesity), younger age of stroke onset, and higher proportion of strokes hemorrhagic diseases than in high-income countries, and the burden of infectious diseases that generates competition for limited health resources.
• The main barriers to high-quality stroke surveillance, prevention, acute care and rehabilitation are: low awareness of stroke and its evidence-based management among communities, health professionals and clinicians. policymakers, and limited surveillance data on stroke risk factors and events. , management and results to enable quality improvement and priority setting. Key enablers include professional stroke organizations and networks that could promote and develop capacity for stroke care and research, and universal health coverage that can facilitate access for the entire population to evidence-based care (pre-hospital care, intensive care, rehabilitation and prevention). .
• The total cost of stroke (both direct treatment and rehabilitation costs and indirect costs due to loss of income) will increase from $891 billion per year in 2017 to up to $2.31 trillion in 2050. However, this increase can be avoided because stroke is highly preventable and treatable. To mitigate this enormous expense and reduce the burden of stroke globally, governments, health ministries and other stakeholders must apply the pragmatic approaches we suggest.
• Global investment in stroke surveillance, prevention, treatment and rehabilitation will accelerate the achievement of Sustainable Development Goal 3.4, which aims to reduce premature mortality from non-communicable diseases by one-third by 2030. Reduce the global burden of stroke cerebrovascular is essential to promote brain health and for overall health and well-being.
Key priorities to reduce the burden of stroke
Surveillance
• Incorporate stroke and risk factor surveillance into national stroke action plans.
• Establish low-cost surveillance systems, ideally within existing systems for non-communicable diseases, to appropriately guide prevention and treatment.
• Incorporate periodic national surveillance of risk factors into national censuses.
Prevention
• Establish an intersectoral system for the primary, primary and secondary prevention of stroke in the entire population. Preventive strategies, with emphasis on lifestyle modification, should be implemented for people at any level of risk for stroke and cardiovascular disease. Primary and secondary stroke prevention services should be freely accessible and supported by universal health coverage, with access to affordable medicines for the treatment of hypertension, dyslipidemia, diabetes and bleeding disorders. Governments should allocate a fixed proportion of their annual healthcare funding to the prevention of stroke and related non-communicable diseases. This funding could come from taxes on tobacco, salt, alcohol and sugar.
• Increase public awareness and take measures to promote a healthy lifestyle and prevent stroke by deploying digital technologies to the entire population (the so-called mass individual motivation strategy for stroke prevention) with simple and inexpensive screening of cardiovascular diseases and modifiable risk factors. This strategy should be reinforced by health professionals through digital technologies for person-centered primary and secondary prevention of stroke and cardiovascular diseases, linked to national electronic health databases.
• Establish protocol-based task shifting (or sharing) from highly trained healthcare professionals to incentivized, supervised and certified paramedical healthcare workers, particularly community healthcare workers, to facilitate primary stroke prevention interventions across the entire population. in rural and urban environments.
Acute care
• Prioritize effective planning of acute stroke care services; capacity development, training and certification of a multidisciplinary workforce; supply of evidence-based cheap and affordable medicines; and adequate allocation of resources at the national and regional levels.
• Establish regional networks and protocol-driven services, including community-wide awareness campaigns for early stroke recognition, regionally coordinated pre-hospital services, telemedicine networks, and stroke centers that can triage and treat all stroke cases. acute cerebrovascular accident and facilitate timely access. to reperfusion therapy, including intravenous thrombolysis or mechanical thrombectomy for ischemic stroke.
• Integrate acute care networks across all pillars of the resource quadrilateral, including surveillance, prevention and rehabilitation services, involving all relevant stakeholders (i.e. communities, policy makers, non-governmental organisations, national organizations and regional stroke organizations, and public and private health care providers) in the continuum of stroke care.
Rehabilitation
• Establish multidisciplinary rehabilitation services and adapt evidence-based recommendations to the local context, including training, support and supervision of community health workers and caregivers to assist in long-term care.
• Invest in research to generate innovative, low-cost interventions, in public awareness to improve demand for rehabilitation services, and in advocacy to mobilize resources and financial solutions for multidisciplinary rehabilitation, especially in low- and middle-income countries.
• Promote the training of stroke rehabilitation professionals. Use digital portals to improve training and expand the use of assessment tools, such as the modified Rankin Scale and the US National Institutes of Health Stroke Scale, and quality of life measures to assess decline functional and monitor recovery.
