Stroke could cause nearly 10 million deaths annually by 2050: Lancet study

The number of people who die from stroke globally is estimated to increase by 50 per cent by 2050 to 9.7 million deaths per year, with annual costs as high as USD 2.3 trillion possible, unless urgent action is taken, according to a new study published in the Lancet Neurology journal.

The analysis forecasts growing health and economic impacts from stroke between 2020 and 2050, which will disproportionately affect lower and middle-income countries (LMICs). Based on a review of evidence-based guidelines, recent surveys, and in-depth interviews with stroke experts around the world, the authors make evidence-based pragmatic recommendations to reduce the global burden, including measures to improve stroke surveillance, prevention, acute care, and rehabilitation.

The number of people who suffer a stroke, die from, or remain disabled by the condition globally has almost doubled over the past 30 years, with the vast majority of those affected in LMICs, where the prevalence of the condition is increasing at a faster rate than in HICs, they said.

If the current trends continue, one of the World Health Organization’s key Sustainable Development Goals (SDGs) will not be met, they said.

SDG 3.4 aims to reduce the 41 million premature deaths from non-communicable diseases – including stroke – by one-third by 2030. While achieving these would require USD 140 billion in new spending between 2023 and 2030, the financial benefits would outweigh the costs by ten-to-one.

“Stroke exerts an enormous toll on the world’s population, leading to the death and permanent disability of millions of people each year, and costing billions of dollars,” said Professor Valery L. Feigin, of Auckland University of Technology, New Zealand, and Commission co-chair.

”Precisely forecasting the health and economic impacts of stroke decades into the future is inherently challenging given the levels of uncertainty involved, but these estimates are indicative of the ever-increasing burden we will see in the years ahead unless urgent, effective action is taken,” Feigin said.

In the new Commission, the authors used the Global Burden of Disease (GBD) study methods to provide estimates of stroke burden between 2020 and 2050 in HICs, LMICs and by major GBD world regions and age.

Taking into account population growth and aging in most countries, their analysis indicates the number of people who die annually from stroke globally will increase by 50 per cent, rising from 6.6 million in 2020 to 9.7 million in 2050.

The number of stroke deaths in LMICs is projected to rise sharply – widening the gap with HICs – by increasing from 5.7 million in 2020 to 8.8 million in 2050. In contrast, stroke deaths in HICs are estimated to remain largely unchanged at around 900,000 (9 lakh) between 2020 and 2050. This indicates that the proportion of global stroke deaths that occur in LMICs will increase from 86 per cent in 2020 to 91 per cent in 2050. “Asia accounted for by far the greatest share of global stroke deaths in 2020 (61 per cent, around 4.1 million deaths) and this is forecast to rise to around 69 per cent by 2050 (around 6.6 million deaths). Though smaller relative to Asia, the number of annual global stroke deaths occurring in Sub-Saharan African countries will rise from 6 per cent in 2020 (403,000) to 8 per cent (765,000) in 2050,” said Professor Jeyaraj Pandian, President-Elect of the World Stroke Organization, one of the lead authors of the Commission.

“We have to closely examine what is causing this increase, including the growing burden of uncontrolled risk factors – especially high blood pressure, and lack of stroke prevention and care services in these regions. Without urgent action, stroke deaths in Southeast Asia, East Asia, and Oceania could increase by almost 2 million deaths, from 3.1 million in 2020 to potentially 4.9 million in 2050,” Pandian said.

While the global death rate among people aged over 60 years is predicted to fall by 36 per cent (566 deaths per 100,000 in 2020 to 362 per 100,000 in 2050), among those under 60 years it is predicted to fall by less than 25 per cent (13 per 100,000 in 2020 to 10 per 100,000 in 2050).

The Commission authors say the lesser reduction among younger people might relate to increasing levels of diabetes and obesity in this age group. Economic forecasting indicates the combined cost of stroke, including direct costs and loss of income, will rise from USD 891 billion per year in 2017 to USD 2.31 trillion in 2050. The bulk of these economic impacts are forecast to be felt in Asia and Africa. Projections indicate large increases in direct costs and income losses from stroke in middle-income countries and increases in direct costs in HICs. They also forecast increased economic impacts in low-income countries, but their overall share in global costs is likely to remain small, given their overall low share in global population and stroke cases.

To identify key barriers and facilitators to high-quality stroke surveillance, prevention, acute care and rehabilitation, the Commission authors conducted a qualitative analysis of in-depth interviews with 12 stroke experts from six HICs and six LMICs.

Among the major barriers identified were low awareness of stroke and its risk factors (which include high blood pressure, diabetes mellitus, high cholesterol, obesity, unhealthy diet, sedentary lifestyle, and smoking), and limited surveillance data on stroke risk factors, events, management, and outcomes of stroke.

Major facilitators included well-developed stroke organisations and networks that can build capacity for stroke care and research, and universal healthcare providing population-wide access to evidence-based stroke care.