Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning.
Aims
To provide the most current incidence, mortality and case–fatality data on stroke and describe current availability of stroke units around the world by country.
Methods
We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case–fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population.
Results
Since our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case–fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries.
Conclusion
Up-to-date data on stroke incidence, case–fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low–middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
ThriftAGCadilhacDAThayabaranathanT, et al.Global stroke statistics. Int J Stroke2014; 9: 6–18.
2.
ThriftAGThayabaranathanTHowardG, et al.Global stroke statistics. Int J Stroke2017; 12: 13–32.
3.
Thrift AG, Howard G, Cadilhac DA, et al. (2017) Global Stroke Statistics: an update of mortality data from countries using a broad code of ‘cerebrovascular diseases’. Int J Stroke 12: 796–801.
4.
Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Systemat Rev2013; 9: CD000197.
5.
United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2017 revision, population by five-year age group, region, subregion and country, 1950-2100 (thousands), https://population.un.org/wpp/Download/Standard/Population/ (2017, accessed 14 April 2019).
6.
Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R and Inoue M. Age standardization of rates: a new WHO world standard. Geneva: World Health Organization (GPE discussion paper series: No. 31, http://www.who.int/whosis/indicators/compendium/2008/1mst/en/ (2001, accessed 6 January 2010).
7.
CadilhacDAKimJLanninNA, et al.National stroke registries for monitoring and improving the quality of hospital care: a systematic review. Int J Stroke2015; 11: 28–40.
8.
RingelsteinEBChamorroAKasteM, et al.European Stroke Organisation recommendations to establish a stroke unit and stroke center. Stroke2013; 44: 828–840.
DasSKBanerjeeTKBiswasA, et al.A prospective community-based study of stroke in Kolkata, India. Stroke2007; 38: 906–910.
11.
PandianJDSinghGKaurP, et al.Incidence, short-term outcome, and spatial distribution of stroke patients in Ludhiana, India. Neurology2016; 86: 425.
12.
WangJBaiLShiM, et al.Trends in age of first-ever stroke following increased incidence and life expectancy in a low-income Chinese population. Stroke2016; 47: 929–935.
13.
LacklandDTRoccellaEJDeutschAF, et al.Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke2014; 45: 315–353.
14.
LiLBinneyLECarterSGutnikovSA, et al.Sensitivity of administrative coding in identifying inpatient acute strokes complicating procedures or other diseases in UK hospitals. J Am Heart Assoc2019; 8: e012995.
15.
PandianJDWilliamAGKateMP, et al.Strategies to improve stroke care services in low- and middle-income countries: a systematic review. Neuroepidemiology2017; 49: 45–61.
16.
JohnsonCONguyenMRothGA, et al.Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol2019; 18: 439–458.
17.
KyuHHAbateDAbateKH, et al.Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet2018; 392: 1859–1922.
18.
RuddAGHoffmanAIrwinPPearsonMLoweD. Stroke units: research and reality. Results from the National Sentinel Audit of Stroke. Qual Safety Health Care2005; 14: 7.
King's College London for the Stroke Alliance for Europe (SAFE). The Burden of Stroke in Europe Report 2017, https://strokeeurope.eu/ (accessed 11 November 2019).
21.
AzarpazhoohMREtemadiMMDonnanGA, et al.Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke2010; 41: e3–e10.
22.
CorbinDOCPoddarVHennisA, et al.Incidence and case fatality rates of first-ever stroke in a Black Caribbean population: the Barbados Register of Strokes. Stroke2004; 35: 1254–1258.
23.
CorsoGBottacchiEGiardiniG, et al.Community-based study of stroke incidence in the Valley of Aosta, Italy. CARe-cerebrovascular Aosta Registry: years 2004-2005. Neuroepidemiology2009; 32: 186–195.
24.
FeiginVLLawesCMBennettDAAndersonCS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol2003; 2: 43–53.
25.
FeiginVLLawesCMBennettDABarker-ColloSLParagV. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol2009; 8: 355–369.
26.
KellyPJCrispinoGSheehanO, et al.Incidence, event rates, and early outcome of stroke in Dublin, Ireland: The North Dublin Population Stroke Study. Stroke2012; 43: 2042–2047.
27.
KuleshSDFilinaNAFrantavaNM, et al.Incidence and case-fatality of stroke on the East Border of the European Union. Stroke2010; 41: 2726–2730.
28.
LeydenJMKleinigTJNewburyJ, et al.Adelaide Stroke Incidence study: declining stroke rates but many preventable cardioembolic strokes. Stroke2013; 44: 1226–1231.
29.
OlindoSChaussonNMejdoubiM, et al.Trends in incidence and early outcomes in a Black Afro-Caribbean population from 1999 to 2012: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux II Study. Stroke2014; 45: 3367–3373.
30.
PikijaSCvetkoDMalojčićB, et al.A population-based prospective 24-month study of stroke: incidence and 30-day case-fatality rates of first-ever strokes in Croatia. Neuroepidemiology2012; 38: 164–171.
31.
Sienkiewicz-JaroszHGluszkiewiczMPniewskiJ, et al.Incidence and case fatality rates of first-ever stroke—comparison of data from two prospective population-based studies conducted in Warsaw. Neurologia i Neurochirurgia Polska2011; 45: 207–212.
32.
SugamaCIsaKOkumuraKIsekiKKinjoKOhyaY. Trends in the incidence of stroke and cardiovascular risk factors on the isolated island of Okinawa: the Miyakojima Study. J Stroke Cerebrovasc Dis2012; 22: e118–e123.
33.
The European Registers of Stroke Investigators. Incidence of stroke in Europe at the beginning of the 21st Century. Stroke2009; 40: 1557–1563.
34.
ZhangYChapmanAMPlestedMJacksonDPurroyF. The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review. Stroke Res Treat2012. Article ID 436125. DOI: 10.1155/2012/436125.
35.
BejotYOssebyGVAboa-EbouleC, et al.Dijon's vanishing lead with regard to low incidence of stroke. Eur J Neurol2009; 16: 324–329.
36.
BenamerHTGrossetD. Stroke in Arab countries: a systematic literature review. J Neurol Sci2009; 284: 18–23.
37.
VegaTZurriagaORamosJM, et al.Stroke in Spain: epidemiologic incidence and patterns; a health sentinel network study. J Stroke Cerebrovasc Dis2009; 18: 11–16.
38.
Ramalle-GomaraERuizESerranoMBártulosMGonzálezM-ÁMatute B. Hospital discharges and mortality registries: 2 complementary databases for the epidemiological surveillance of stroke. J Stroke Cerebrovasc Dis2013; 22: e441–e445.
39.
JiangBWangWZChenH, et al.Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke2006; 37: 63–68.
40.
SymePDByrneAWChenRDevennyRForbesJF. Community-based stroke incidence in a Scottish population: the Scottish Borders Stroke Study. Stroke2005; 36: 1837–1843.
41.
MinelliCFenLFMinelliDP. Stroke incidence, prognosis, 30-day, and 1-year case fatality rates in Matao, Brazil: a population-based prospective study. Stroke2007; 38: 2906–2911.
42.
SridharanSEUnnikrishnanJPSukumaranS, et al.Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke2009; 40: 1212–1218.
43.
CorsoGBottacchiEGiardiniG, et al.Epidemiology of stroke in Northern Italy: the Cerebrovascular Aosta Registry, 2004–2008. Neurol Sci2012; 34: 1071–1081.
44.
SajjadAChowdhuryRFelixJF, et al.A systematic evaluation of stroke surveillance studies in low- and middle-income countries. Neurology2013; 80: 677–684.
45.
FeiginVLKrishnamurthiRVBarker-ColloS, et al.30-Year trends in stroke rates and outcome in Auckland, New Zealand (1981–2012): a multi-ethnic population-based series of studies. PLoS ONE2015; 10: e0134609.
46.
AndersonCSJamrozikKDBurvillPWChakeraTMJohnsonGAStewart-WynneEG. Ascertaining the true incidence of stroke: experience from the Perth Community Stroke Study, 1989–1990. Med J Austr1993; 158: 80–84.
47.
AppelrosPNydevikISeigerATerentA. High incidence rates of stroke in Orebro, Sweden: further support for regional incidence differences within Scandinavia. Cerebrovasc Dis2002; 14: 161–168.
48.
BenatruIRouaudODurierJ, et al.Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke2006; 37: 1674–1679.
49.
BonitaRBroadJBBeagleholeR. Changes in stroke incidence and case-fatality in Auckland, New Zealand, 1981–91. Lancet1993; 342: 1470–1473.
50.
CaroleiAMariniCDi NapoliM, et al.High stroke incidence in the prospective community-based L'Aquila registry (1994–1998). First year's results. Stroke1997; 28: 2500–2506.
51.
Di Carlo AInzitariDGalatiF, et al.A prospective community-based study of stroke in southern Italy: the Vibo Valentia incidence of stroke study (VISS). Methodology, incidence and case fatality at 28 days, 3 and 12 months. Cerebrovasc Dis2003; 16: 410–417.
52.
DuXSourbuttsJCruickshankK, et al.A community based stroke register in a high risk area for stroke in north west England. J Epidemiol Commun Health1997; 51: 472–478.
53.
JanesFGigliGLD'AnnaL, et al.Stroke incidence and 30-day and six-month case fatality rates in Udine, Italy: a population-based prospective study. Int J Stroke2013; 8: 100–105.
54.
Kolominsky-RabasPLSartiCHeuschmannPU. A prospective community-based study of stroke in germany. The Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke1998; 29: 2501–2506.
55.
RayBKHazraAGhosalM, et al.Early and delayed fatality of stroke in Kolkata, India: results from a 7-year longitudinal population-based study. J Stroke Cerebrovasc Dis2013; 22: 281–289.
56.
ThriftAGDeweyHMSturmJW, et al.Incidence of stroke subtypes in the North East Melbourne Stroke Incidence Study (NEMESIS): differences between men and women. Neuroepidemiology2009; 32: 11–18.
57.
VemmosKNBotsMLTsibourisPK, et al.Stroke incidence and case fatality in southern Greece: the Arcadia stroke registry. Stroke1999; 30: 363–370.
58.
AshokPPRadhakrishnanKSridharanRel-MangoushMA. Incidence and pattern of cerebrovascular diseases in Benghazi, Libya. J Neurol Neurosurg Psychiat1986; 49: 519–523.
59.
CorreiaMSilvaMRMatosI, et al.Prospective-community based study of stroke in Northern Portugal: incidence and case fatality in rural and urban populations. Stroke2004; 35: 2048–2053.
60.
D'AlessandroGDi GiovanniMRoveyazL, et al.Incidence and prognosis of stroke in the Valle d'Aosta Italy. Stroke1992; 23: 1712–1715.
61.
FeiginVLWiebersDOWhisnantJPO'FallonWM. Stroke incidence and 30-day case-fatality rates in Novosibirsk, Russia, 1982 through 1992. Stroke1995; 26: 924–929.
62.
LauriaGGentileMFassettaG, et al.Incidence and prognosis of stroke in the Belluno Province, Italy: first-year results of a community-based study. Stroke1995; 26: 1787–1793.
63.
LavadosPMSacksCPrinaL, et al.Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet2005; 365: 2206–2215.
64.
MusolinoRLa SpinaPSerraS, et al.First-ever stroke incidence and 30-day case fatality in the Sicilian Aeolian Archipelago, Italy. Stroke2005; 36: 2738–2741.
65.
RicciSCelaniMGLa RosaF, et al.SEPIVAC: a community-based study of stroke incidence in Umbria, Italy. J Neurol Neuros Psych1991; 54: 695–698.
66.
TsiskaridzeADjibutiMvanMG, et al.Stroke incidence and 30-day case-fatality in a suburb of Tbilisi: results of the first prospective population-based study in Georgia. Stroke2004; 35: 2523–2528.
67.
ÅsbergKHParrowA. Event, incidence, and fatality rates of cerebrovascular diseases in Enköping-Håbo, Sweden, 1986-1988. Scand J Public Health1991; 19: 134–139.
68.
MorikawaYNakagawaHNaruseY, et al.Trends in stroke incidence and acute case fatality in a Japanese rural area: the Oyabe study. Stroke2000; 31: 1583–1587.
69.
ViboRKorvJRooseM. The third stroke registry in Tartu, Estonia: decline of stroke incidence and 28-day case -fatality rate since 1991. Stroke2005; 36: 2544–2548.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
