The global burden of stroke: persistent and disabling

According to a report from the Global Burden of Disease (GBD) 2016 Lifetime Risk of Stroke Collaborators,1 the estimated global lifetime risk of stroke in 2016 for those aged 25 years or older was 24·9%, an increase from 22·8% in 1990. In a policy statement crafted by an American Heart Association working group, it was concluded that, by 2030, almost 4% of US adults will have had a stroke, accounting for total direct annual stroke-related medical costs increasing from US$71·55 billion in 2012 to $183·13 billion by 2030.2 Driving the upswing in stroke prevalence rates is a projected increase in stroke attributed to a growing and ageing population and lower stroke case fatality rates associated with better acute ischaemic stroke care and improved recurrent stroke prevention strategies.2 These findings point to the importance of continued surveillance of stroke case fatality, incidence, and recurrence rates.1,2 In The Lancet Neurology, the GBD 2016 Stroke Collaborators3 provide a systematic analysis of the global, regional, and national burden of stroke from 1990 to 2016 in terms of incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). [...]metabolic factors (high systolic blood pressure, body-mass index, fasting plasma glucose, and total cholesterol and low glomerular filtration rate) accounted for 72% of stroke DALYs, behavioural factors (smoking, poor diet, and physical inactivity) accounted for 66%, and environmental risks (air pollution and lead exposure) accounted for about 28%.