Lancet Neurol. 2019 May;18(5):439-458. doi: 10.1016/S1474-4422(19)30034-1. Epub 2019 Mar 11.
Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016.
We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles.
In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (-39·3 to -33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (-37·2 to -31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (-10·7 to -5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men.
Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor.
Bill & Melinda Gates Foundation.
中风是全球范围内导致死亡和残疾的主要原因，治疗和中风后护理的经济成本巨大。全球疾病、伤害和危险因素研究（GBD）提供了一种系统的、可比的方法来量化疾病导致的健康损失，包括中风在内的 300 多种疾病和损伤的信息，为卫生系统和决策者提供了信息。这里呈现的结果是 GBD 2016 中总体中风以及缺血性和出血性中风负担的估计。
我们报告了 1990 年至 2016 年期间的发病率、患病率、死亡率、寿命损失年（YLLs）、残疾生活年（YLDs）和伤残调整生命年（DALYs）的估计值和相应的不确定区间（UI）。DALYs 通过将 YLLs 和 YLDs 相加得出。特定原因的死亡率是使用一个包含人口登记和死因推断数据的综合模型过程来估计的。非致命性估计是使用贝叶斯元回归生成的，该方法结合了来自登记处、科学文献、行政记录和调查的数据。社会人口指数（SDI）是一个综合指标，使用教育程度、滞后分布收入和总生育率生成，用于将国家分为五分位数。
2016 年，有 550 万人（95% UI 为 530 万至 570 万）死于中风，1.164 亿人（1.114 亿至 1.214 亿）因中风而丧失日常生活能力。全球年龄标准化死亡率从 1990 年到 2016 年下降了 36.2%（-39.3%至-33.6%），所有 SDI 五分位数都有所下降。同期，全球年龄标准化 DALY 率下降了 34.2%（-37.2%至-31.5%），所有 SDI 五分位数也都有所下降。2016 年有 1370 万人（1270 万至 1470 万）新发生中风。全球年龄标准化发病率从 1990 年到 2016 年下降了 8.1%（-10.7%至-5.5%），除了中 SDI 组外，所有 SDI 五分位数都有所下降。2016 年全球有 8010 万人（7410 万至 8630 万）患有中风；女性有 4110 万人（3800 万至 4430 万），男性有 3900 万人（3610 万至 4210 万）。
尽管 1990 年至 2016 年期间年龄标准化死亡率大幅下降，但年龄标准化发病率的下降幅度较小，表明中风的负担可能仍然很高。未来 GBD 迭代的计划更新包括分别生成蛛网膜下腔出血和脑内出血的估计数、生成短暂性脑缺血发作的估计数以及将心房颤动作为一个危险因素。
比尔及梅琳达·盖茨基金会。
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