Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years

Abstract

Background and purpose: Prediction of stroke impact provides essential information for healthcare planning and priority setting. We aim to estimate 30-year projections of stroke epidemiology in the European Union using multiple modeling approaches.

Methods: Data on stroke incidence, prevalence, deaths, and disability-adjusted life years in the European Union between 1990 and 2017 were obtained from the global burden of disease study. Their trends over time were modeled using 3 modeling strategies: linear, Poisson, and exponential regressions-adjusted for the gross domestic product per capita, which reflects the impact of economic development on health status. We used the Akaike information criterion for model selection. The 30-year projections up to 2047 were estimated using the best fitting models, with inputs on population projections from the United Nations and gross domestic product per capita prospects from the World Bank. The technique was applied separately by age-sex-country groups for each stroke measure.

Results: In 2017, there were 1.12 million incident strokes in the European Union, 9.53 million stroke survivors, 0.46 million deaths, and 7.06 million disability-adjusted life years lost because of stroke. By 2047, we estimated an additional 40 000 incident strokes (+3%) and 2.58 million prevalent cases (+27%). Conversely, 80 000 fewer deaths (-17%) and 2.31 million fewer disability-adjusted life years lost (-33%) are projected. The largest increase in the age-adjusted incidence and prevalence rates are expected in Lithuania (average annual percentage change, 0.48% and 0.7% respectively), and the greatest reductions in Portugal (-1.57% and -1.3%). Average annual percentage change in mortality rates will range from -2.86% (Estonia) to -0.08% (Lithuania), and disability-adjusted life years' from -2.77% (Estonia) to -0.23% (Romania).

Conclusions: The number of people living with stroke is estimated to increase by 27% between 2017 and 2047 in the European Union, mainly because of population ageing and improved survival rates. Variations are expected to persist between countries showing opportunities for improvements in prevention and case management particularly in Eastern Europe.

Keywords: global burden of disease; health status; incidence; prevalence; stroke.

Figure 1.

Historical trends and future trajectories of stroke incidence, prevalence, deaths, and disability-adjusted life years (DALYs) in the European Union since 1990 and up to 2047. *With reference to 2017 observed rates. †Constructed as detailed in Methods section.

Figure 2.

Projected change in population, incidence, prevalence, deaths, and disability-adjusted life years disability-adjusted life years (DALYs) count by age group in the European Union (2047 vs 2017).

Figure 3.

Projected average annual percentage change in the crude rates of incidence, prevalence, death, and disability-adjusted life years (DALYs) during 2018 to 2047.

Figure 4.

Projected average annual percentage change in the age-standardized rates of incidence, prevalence, death, and disability-adjusted life years (DALYs) during 2018 to 2047.

Figure 5.

Prediction performance of different models in the European Union during a test period (2008–2017). RMSE indicates root mean squared error which reflects the average deviation of the predictions from the observed values over evaluation years (2008–2017).