Stroke Rates Climb as Population Ages, Fall Adjusted for Age

The incidence of new cases of ischemic stroke and deaths from ischemic stroke worldwide has increased over the past 30 years.

However, this is largely due to the ageing of the population, and the age-standardized incidence rate and age-standardized death rate have fallen, a new study shows. 

“The decrease is likely due to better medical services available in high-income countries, which may offer earlier detection of stroke risk factors and better control of these risk factors,” said study author Liyuan Han, PhD, from the University of Chinese Academy of Sciences in Ningbo.

“But even in these countries, the total number of people with strokes is increasing due to population growth and aging. And worldwide stroke is a leading cause of death and disability for adults,” she noted.

The study also showed that stroke burden remains high, particularly in low- and middle-income areas, such as East Asia, Central Asia, Eastern Europe, North Africa, the Middle East, and Eastern sub-Saharan Africa. It was lower in countries in Australasia, Western Europe, North America, and Andean Latin America.

In the study published online in Neurology on December 15, researchers analyzed data from 1990 to 2019 from the Global Health Data Exchange. During that time, the average age-adjusted incidence of ischemic stroke decreased by 0.43%, from 105 to 95 strokes per 100,000 people.

Rates were higher in middle- and high-middle-income countries than elsewhere. The highest were in East Asia with 144 per 100,000 and North Africa, the Middle East and Eastern Europe with rates of 135 per 100,000. Australasia had the lowest rate at 44 strokes per 100,000 people.

At a country level, the highest rates were in the United Arab Emirates, at 208 strokes per 100,000 people, Macedonia, at 187, and Jordan, at 181. The lowest rates were in Ireland, at 36 strokes per 100,000 people, Nepal, at 37, and Switzerland, at 38.

Egypt and China had the most pronounced increases in stroke rates, which went up 1.4% and 1.1%, respectively.

Similar to the stroke occurrence rate, the rate of death from stroke decreased slightly over the 3 decades, or by 1.6%, but the overall numbers were high. The death rate decreased from 66 deaths per 100,000 people to 44.

The highest death rates were in Eastern Europe, with a rate of 100 per 100,000, Central Asia, at 79, and Central Europe, at 67. The lowest rates were in high-income North America, at 16, Australasia, at 17 and high-income Asia Pacific, at 18.

“Since ischemic stroke is highly preventable, it is essential that more resources be devoted to prevention, especially in low- and middle-income countries where economic development is leading to changes in diet and lifestyle that may increase people’s risk factors for stroke,” Han said.

“It has been estimated that at least half of all strokes may be preventable if effective changes were made to common lifestyle factors, such as high blood pressure, obesity, smoking, and inactivity.”

The study was supported by the National Natural Science Foundation of China, the Innovative Talent Support Plan of the Medical and Health Technology Project, the Zhejiang Provincial Public Service and Application Research Foundation, Ningbo Science and Technology Project, Ningbo Health Branding Subject Fund, and Sanming Project of Medicine.

Neurology. Published online December 15, 2021. Abstract

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