Research Information System
LANCET NEUROLOGY, vol.22, pp.1160-1206, 2023 (SCI-Expanded)
Stroke is the second leading cause of death worldwide.
The burden of disability after a stroke is also large, and is
increasing at a faster pace in low-income and middleincome
countries than in high-income countries.
Alarmingly, the incidence of stroke is increasing in young
and middle-aged people (ie, age <55 years) globally.
Should these trends continue, Sustainable Development
Goal 3.4 (reducing the burden of stroke as part of the
general target to reduce the burden of non-communicable
diseases by a third by 2030) will not be met.
In this Commission, we forecast the burden of stroke
from 2020 to 2050. We project that stroke mortality will
increase by 50%—from 6·6 million (95% uncertainty
interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million
(8·0 million–11·6 million) in 2050—with disabilityadjusted
life-years (DALYs) growing over the same period
from 144·8 million (133·9 million–156·9 million) in 2020,
to 189·3 million (161·8 million–224·9 million) in 2050.
These projections prompted us to do a situational analysis
across the four pillars of the stroke quadrangle:
surveillance, prevention, acute care, and rehabilitation. We
have also identified the barriers to, and facilitators for, the
achievement of these four pillars.
On the basis of our assessment, we have identified
and prioritised several recommendations. For each of
the four pillars (surveillance, prevention, acute care, and
rehabilitation), we propose pragmatic solutions for
the implementation of evidence-based interventions
to reduce the global burden of stroke. The estimated
direct (ie, treatment and rehabilitation) and indirect
(considering productivity loss) costs of stroke globally are
in excess of US$891 billion annually. The pragmatic
solutions we put forwards for urgent implementation
should help to mitigate these losses, reduce the global
burden of stroke, and contribute to achievement
of Sustainable Development Goal 3.4, the WHO
Intersectoral Global Action Plan on epilepsy and other
neurological disorders (2022–2031), and the WHO Global
Action Plan for prevention and control of noncommunicable
diseases.
Reduction of the global burden of stroke, particularly
in low-income and middle-income countries, by
implementing primary and secondary stroke prevention
strategies and evidence-based acute care and rehabilitation
services is urgently required. Measures to
facilitate this goal include: the establishment of a
framework to monitor and assess the burden of stroke
(and its risk factors) and stroke services at a national
level; the implementation of integrated population-level
and individual-level prevention strategies for people at
any increased risk of cerebrovascular disease, with
emphasis on early detection and control of hypertension;
planning and delivery of acute stroke care services,
including the establishment of stroke units with access
to reperfusion therapies for ischaemic stroke and
workforce training and capacity building (and
monitoring of quality indicators for these services
nationally, regionally, and globally); the promotion of
interdisciplinary stroke care services, training for
caregivers, and capacity building for community health
workers and other health-care providers working
in stroke rehabilitation; and the creation of a
stroke advocacy and implementation ecosystem that
includes all relevant communities, organisations, and
stakeholders.