Lancet. 2014 Jan 18;383(9913):245-54. doi: 10.1016/s0140-6736(13)61953-4.
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 nonsignificantly. 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 fi rst 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.
背景：尽管中风是全球范围内的第二大致死原因，但对于大多数地区而言，其发病率、患病率、死亡率、残疾和流行病学趋势尚未进行全面和可比的评估。我们使用 2010 年全球疾病、伤害和危险因素研究（GBD 2010）的数据来评估 1990-2010 年期间全球和区域的中风负担。
方法：我们从 1990 年到 2012 年在 Medline、Embase、LILACS、Scopus、PubMed、Science Direct、全球卫生数据库、世界卫生组织图书馆和世界卫生组织区域数据库中检索了相关研究，以确定 1990 年至 2010 年期间发表的研究。我们应用 GBD 2010 分析技术（DisMod-MR），该技术基于特定疾病的发病、流行和死亡率之间的特定关联，计算了特定区域和国家的中风发病率、流行率、死亡率和残疾调整生命年（DALYs）的损失，根据年龄组（<75 岁、≥75 岁和总计）和国家收入水平（高收入和低收入和中等收入）计算了 1990 年、2005 年和 2010 年的中风发病率、流行率、死亡率和残疾调整生命年（DALYs）的损失。
结果：我们纳入了 119 项研究（58 项来自高收入国家，61 项来自低收入和中等收入国家）。从 1990 年到 2010 年，高收入国家中风的年龄标准化发病率显著下降了 12%（95%CI 6-17），而低收入和中等收入国家中风的发病率则上升了 12%（-3 至 22），但无统计学意义。高收入国家（37%，31-41）和低收入和中等收入国家（20%，15-30）的死亡率均显著下降。2010 年，首次中风（1690 万人）、中风幸存者（3300 万人）、中风相关死亡（590 万人）和残疾调整生命年（1.02 亿）的人数较高，自 1990 年以来显著增加（分别增加了 68%、84%、26%和 12%），大部分负担（中风发病率的 68.6%、中风患病率的 52.2%、中风死亡率的 70.9%和 DALYs 损失的 77.7%）来自低收入和中等收入国家。2010 年，520 万人（31%）的中风发生在儿童（<20 岁）和中青年成年人（20-64 岁），其中来自低收入和中等收入国家的儿童和中青年成年人分别占中风负担的近 74000（89%）和 400 万人（78%）。此外，我们还注意到，在 GBD 区域和国家之间，中风负担存在 3 到 10 倍的显著地理差异。超过 62%的新发中风、69.8%的现患中风、45.5%的中风死亡和 71.7%的因中风而导致的残疾调整生命年（DALYs）损失发生在年龄小于 75 岁的人群中。
解释：尽管过去二十年来全球中风死亡率的年龄标准化率有所下降，但每年发生中风的人数、中风幸存者、相关死亡人数以及全球中风负担（残疾调整生命年）仍然很大且在增加。需要进一步研究以更好地了解全球中风的决定因素和负担，并确定不同收入水平国家之间中风负担差异和趋势变化的原因。
资助：比尔及梅琳达·盖茨基金会。
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