The global burden of stroke and need for a continuum of care

Abstract

Until 4 decades ago, the rates of stroke in low- and middle-income countries were considerably lower than those in more economically robust countries. In the intervening years, however, the rates of stroke in places such as southern India and rural South Africa have approximately doubled, whereas stroke rates in more economically developed nations have decreased. What is far more striking is that rates of disability and mortality arising from stroke are at least 10 times greater in medically underserved regions of the world compared with the most developed nations. The causes of these disparities are clear: above all, there is a lack of primary care treatment to screen patients for stroke risk and to mitigate risk factors. In addition, the lack of access to common drugs and basic medical equipment, as well as the lack of poststroke follow-up programs, rehabilitation, and secondary stroke prevention, means that individuals who would, in countries with better medical care, likely recover from stroke, instead have high rates of death and disability. Several global organizations, most notably the World Health Organization, have formulated and begun to implement public health programs to address these underserved regions. Their success depends on the support and expansion of these efforts so that short-term response to stroke, long-term stroke prevention and care, and screening and treatment of poststroke disabilities can be improved in underserved regions and the human and economic burden on these populations can be minimized.

Figure 1. Age-adjusted stroke incidence in high-income countries vs low- and middle-income countries

Age-adjusted stroke incidence rates per 100,000 people across the 4 study periods: 1970–1979, 1980–1989, 1990–1999, and 2000–2008. (A) High-income countries. (B) Low- and middle-income countries. Solid line is regression trend line based on a regression of average incidence on study period. Reprinted from The Lancet Neurology, vol. 8, issue 4, Feigin et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review, pp. 355–369, ©2009, with permission from Elsevier.

Figure 2. Global stroke mortality rates (adjusted for age and gender)

Reprinted from The Lancet Neurology, vol. 8, issue 4, Johnston et al. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modeling, pp. 345–354, ©2009, with permission from Elsevier.