Stroke incidence rates
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Global Stroke Incidence Rates and Trends
Stroke remains a major global health issue, with significant variation in incidence rates across regions and over time. In 2019, there were approximately 12.2 million new cases of stroke worldwide, making stroke the second-leading cause of death and the third-leading cause of death and disability combined globally . The age-standardized incidence rate of stroke has decreased by 17% from 1990 to 2019, but the absolute number of strokes has increased due to population growth and aging . Notably, low- and middle-income countries have seen a more than 100% increase in stroke incidence over the past four decades, and for the first time in 2000–2008, their incidence rates surpassed those of high-income countries by 20% .
Regional Stroke Incidence Rates
India
In India, the crude incidence of stroke ranges from 108 to 172 per 100,000 people per year, based on data from several cities and regions . The burden of stroke is increasing, and it is now the fourth leading cause of death in the country .
China
China has one of the highest stroke burdens globally. A 2013 nationwide survey found an age-standardized incidence rate of 246.8 per 100,000 person-years, with higher rates in the northern and central regions compared to the south . The stroke burden in China has increased over the past 30 years, especially in rural areas .
Australia and New Zealand
In the Hunter region of Australia, age-standardized hospitalised stroke incidence rates declined from 123 per 100,000 in 2001–2005 to 96 per 100,000 in 2016–2019 . In Adelaide, the crude incidence rate for first-ever strokes was 161 per 100,000 per year, with adjusted rates of 76 per 100,000 . In Auckland, New Zealand, age-standardized stroke incidence rates decreased from 156 per 100,000 in 1981–1982 to 124 per 100,000 in 2021–2022 .
United States
In the Greater Cincinnati/Northern Kentucky region, the overall annual incidence of stroke in 2020 was 203 per 100,000 . Over the past decades, stroke incidence rates have generally decreased, especially in men, but recent data show that the decline has stalled, and there was an increase in stroke incidence between 2015 and 2020, mainly due to ischemic strokes in white adults 89.
Age and Sex Differences in Stroke Incidence
Recent studies indicate a shift toward younger ages at stroke onset. The mean age at stroke has decreased, and the proportion of strokes in people under 55 has increased significantly . In Auckland, the mean age of stroke patients dropped from 73.0 years in 2002–2003 to 70.7 years in 2021–2022, with a 1.28% annual increase in incidence among those aged 15–54 . Sex-specific trends show that while stroke incidence has decreased in men, the decline is less pronounced in women, and by 2010, incidence rates were similar between sexes .
Racial and Ethnic Disparities
Racial and ethnic disparities in stroke incidence persist. In the US, Black adults have a significantly higher risk of stroke compared to White adults (risk ratio 1.84), and rates of intracerebral and subarachnoid hemorrhage remain higher in Black populations . In New Zealand, Māori and Pacific people have 1.5 to 2 times higher risk of stroke compared to NZ Europeans .
Stroke Subtypes and Risk Factors
Ischemic stroke is the most common subtype, accounting for about 62–78% of incident strokes globally and in large national studies 237. The leading risk factors for stroke include high systolic blood pressure, high body-mass index, high fasting plasma glucose, air pollution, and smoking . In China, hypertension, smoking, and alcohol use are the most prevalent risk factors among stroke survivors .
Conclusion
Stroke incidence rates show significant regional, age, sex, and racial variation. While age-standardized rates have declined in many high-income countries, the absolute number of strokes is rising globally, especially in low- and middle-income countries. There is a concerning trend of increasing stroke incidence among younger adults and persistent disparities among ethnic and racial groups. Continued surveillance and targeted prevention strategies are essential to address the growing and shifting burden of stroke worldwide 2456+4 MORE.
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Most relevant research papers on this topic
Stroke in India: A systematic review of the incidence, prevalence, and case fatality
Stroke incidence in India ranges from 108 to 172/100,000 people per year, with a prevalence of 26 to 757/100,000 people per year, and one-month case fatality rates of 18% to 42%.
Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
The global burden of stroke increased from 1990 to 2019, with high body-mass index being the fastest-growing risk factor, and the highest mortality rates in low-income countries.
Adelaide Stroke Incidence Study: Declining Stroke Rates but Many Preventable Cardioembolic Strokes
Stroke incidence in Adelaide has not increased despite the aging population, but cardioembolic strokes are becoming a higher proportion of all ischemic strokes.
Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.
Stroke incidence rates have decreased in high-income countries but increased in low to middle income countries, highlighting the need for action in these areas.
Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults
Stroke burden in China has increased over the past 30 years, with the greatest burden observed in northern and central regions, and a north-to-south gradient in incidence and mortality.
Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study
Decreases in stroke incidence over time are driven by a decrease in ischemic stroke in men, with stroke incidence rates being similar between women and men in 2010.
Abstract 54: Stroke Incidence by Race in a Large, Biracial Population Over Time: 2020 Update
Between 2015 and 2020, overall stroke incidence in a large, biracial population increased, mainly driven by an increase in ischemic stroke in whites, with ICH/SAH rates stably higher in blacks compared to whites.
Transition in Incidence Rate of Hospitalised Stroke and Case Fatality Rate in the Hunter Region, Australia, 2001-2019: A Prospective Hospital-Based Study.
In the Hunter region, Australia, age-standardised hospitalized stroke incidence rates declined from 2001-2005 to 2016, but an increase in stroke hospitalizations is expected due to population aging.
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