Qian Nannan, Lu Chengcheng, Wei Taohua, Yang Wenming, Wang Han, Chen Huaizhen, Li Jun, Zhu Sihuan, Wang Weiqi, Shao Ningshu
Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China; Anhui University of Chinese Medicine First Clinical Medical College, Hefei, Anhui 230031, China; Key Laboratory of Xin'An Medicine, Ministry of Education, Hefei, Anhui 230031, China; Graduate School, Anhui University of Chinese Medicine, Hefei, Anhui 230031, China.
Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China; Clinical College of Anhui Medical University, Hefei, Anhui 230031, China.
J Stroke Cerebrovasc Dis. 2025 May 15;34(8):108347. doi: 10.1016/j.jstrokecerebrovasdis.2025.108347.
Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.
The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.
From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.
Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.
中风分为缺血性或出血性，会导致严重的发病率、死亡率和复发率。本研究分析了1990年至2021年中风的流行病学趋势。
全球疾病负担数据库提供了中风数据，包括发病率、死亡率和伤残调整生命年（DALYs）。年龄标准化率（ASRs）和估计年变化百分比（EAPC）用于衡量发病率和死亡率的变化。社会人口指数（SDI）与中风负担一起进行了探讨。利用贝叶斯年龄-时期-队列（BAPC）模型预测了到2035年的中风趋势。对影响中风负担变异性的因素进行了分解分析，以进行更深入的研究。此外，采用前沿分析直观地展示了每个国家或地区减轻负担的机会，同时考虑到它们各自的发展阶段。本研究利用世界卫生组织（WHO）定义的不平等斜率指数（SII）和集中指数，评估疾病负担的绝对和相对不平等。
1990年至2021年，全球中风发病率上升了15.03%，年龄标准化发病率（ASIR）总体下降。女性发病率低于男性，但女性发病率上升幅度更大。中风死亡率总体下降了2.60%，男性死亡率上升，女性死亡率下降。DALYs增加，每10万人的发病率下降了10.67%。东欧、中亚和东亚的发病率最高，高收入亚太地区的ASIR下降幅度最大。分解分析显示，社会人口指数（SDI）中位数五分位数区域内的伤残调整生命年（DALYs）显著上升，其中老龄化和人口增长等因素被确定为主要促成因素。此外，前沿分析表明，SDI五分位数较高的国家或地区可能具有更大的改善潜力。2035年的预测预计中风病例会增加，同时ASIR和ASMR会进一步下降。跨国不平等分析表明，1990年至2021年期间，与中风负担相关的绝对和相对健康不平等都有所加剧。
尽管全球中风发病率和DALYs上升，但自1990年以来ASIR和ASMR有所下降。女性发病率上升最快，存在区域差异。高收缩压仍然是一个关键风险因素。未来的努力应针对预防和治疗，以减轻性别、年龄和地区中风差异。
