We noted a significant increase of CI in the

We noted a significant increase of 22% (95% CI 5–30) in the incidence of haemorrhagic stroke in low-income and middle-income countries in the past two decades, with a 19% (5–30) significant increase in people younger than 75 years. A non-significant increase of 6% (18%, −7 to 32) was shown in the incidence of ischaemic stroke; additionally, mortality rates were reduced by 14% (–2% to 32), DALYs lost by 16% (1–35%), and mortality-to-incidence ratio by 16% (–5% to 37); however, these XAV939 manufacturer differences were not significant. Similarly for haemorrhagic stroke, mortality rates were reduced by 23% (–3% to 36%), DALYs lost by 25% (7–38%), and mortality-to-incidence ratio by 36% (16–49%), likewise not significantly. In the past two decades, the incidence of both ischaemic and haemorrhagic stroke in low-income and middle-income countries increased significantly in people aged 20–64 years (table 3). Worldwide, the mean age of people with incident and fatal stroke has increased in the past two decades, with the largest increase noted in high-income countries (table 4). In 2010, the mean age of patients with incident and fatal ischaemic and haemorrhagic stroke was 3–5 years greater in high-income than in low-income to middle-income countries (table 4). By GBD region, in the past two decades, the largest increases in incidence of ischaemic stroke were in eastern Europe, central and east Asia, north and sub-Saharan Africa, and the Middle East (figure 1), with the largest increase (22%) noted in the Democratic Republic of Congo. Notably, some of the largest decreases in incidence of ischaemic stroke between 1990 and 2010 were also in these regions (South Korea 44%, Chile 41%, Brunei 41%; figure 1). Up to 2010, the highest rates of ischaemic stroke were in eastern Europe (particularly Russia: 238–416/100 000) and central and east Asia, North Africa, and the Middle East (178–238/100 000). The largest increases in incidence of haemorrhagic stroke by GBD region were in eastern and central Europe, North and sub-Saharan Africa, and the Middle East, whereas in high-income regions of North America, western Europe, and tropical and southern Latin America incidence of haemorrhagic stroke decreased significantly (figure 2). In 2010, the highest incidences of haemorrhagic stroke were in central and east Asia (101–158/100 000) and east and southern sub-Sahara Africa (73–101/100 000), whereas the lowest rates were in high-income North America, central and Andean Latin America, western Europe, and Oceania (Australasia; 25–40/100 000). Between 1990 and 2010, mortality-to-incidence ratios for ischaemic stroke noticeably reduced in western Europe, Australasia, and central and Andean Latin America, but increased in North Africa, the Middle East, and southeast Asia (figure 3). For haemorrhagic stroke, we noted decreases in mortality-to-incidence ratios in northern Africa; the Middle East; central, east, and southern sub-Saharan Africa; and east and southeast Asia, whereas moderate increases were evident in central Latin America and high-income Asia-Pacific regions (figure 4). In 2010, the lowest mortality-to-incidence ratios for ischaemic stroke were in high-income North America and east Asia (0·17–0·19) and for haemorrhagic stroke in high-income North America (0·25). The highest mortality-to-incidence ratios for ischaemic stroke were in central Europe and the Caribbean (0·34–0·38), and for haemorrhagic stroke in Oceania (0·94–1·27). In 2010, the age-specific incidences of ischaemic and haemorrhagic stroke increased significantly with age in all GBD regions (figures 5, 6). Although we noted no differences in the age-specific incidence of ischaemic stroke between high-income and low-income countries (figure 5), age-specific rates of haemorrhagic stroke increased in low-income to middle-income countries (figure 6). Age-specific rates were significantly greater in people older than 45 years in low-income to middle-income countries than in high-income countries. Age-specific mortality rates, mortality-to-incidence ratios, and DALYs for both stroke types were greater overall in low-income to middle-income countries than in high-income countries, but significant differences between higher-income and lower-income countries were only apparent for haemorrhagic stroke incidence, mortality, DALYs in people older than 40 years, and for mortality-to-incidence ratios across all age groups (figures 5, 6).
Discussion This study is the first to report the global burden of ischaemic and haemorrhagic stroke in terms of incidence, mortality, DALYs lost, and mortality-to-incidence ratio across GBD regions and countries in 1990, 2005, and 2010, and across all age groups of the population. Several important findings were shown (panel). First, the burden of both stroke types has increased significantly between 1990 and 2010 in terms of an increased absolute number of people with incident stroke, number of deaths, and number of DALYs lost. Although the absolute number of incident ischaemic stroke was twice alpha decay of haemorrhagic stroke, the overall global burden of haemorrhagic stroke (deaths and DALYs) was higher. Whereas the main stroke pathological type in high-income countries was ischaemic stroke, most stroke burden worldwide was due to haemorrhagic stroke.