Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 15:43:101017.
doi: 10.1016/j.lana.2025.101017. eCollection 2025 Mar.

Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021

Ramón Martinez  1 , Paula Muñoz-Venturelli  2 , Pedro Ordunez  1 , Felipe Fregni  3 , Carlos Abanto  4 , Matias Alet  5   6 , Tony Fabián Alvarez  7 , Pablo Amaya  8 , Sebastian Ameriso  5 , Antonio Arauz  9 , Miguel A Barboza  10 , Hernán Bayona  11   12 , Antonio Bernabé-Ortiz  13 , Juan Calleja  9 , Vanessa Cano-Nigenda  9 , Leonardo Augusto Carbonera  14 , Rodrigo M Carrillo-Larco  15 , Angel Corredor  16 , Ana Cláudia de Souza  14 , Claudio Jimenez  12 , Fernando Lanas  17 , Sheila Martins  14   18   19 , Victor Navia  20   21 , Nelson Novarro-Escudero  22 , Verónica Olavarría  20 , Bruce Ovbiagele  23 , Kevin Pacheco-Barrios  24 , Octavio Pontes-Neto  25 , Virginia Pujol  5 , Alejandro Rabinstein  26 , Julieta Rosales  5 , Andrés Rosende  1 , Gisele Sampaio Silva  27 , Gustavo Saposnik  28 , Souvik Sen  29 , Fernando D Testai  30 , Victor Urrutia  31 , Craig S Anderson  32   33 , Pablo M Lavados  20
Affiliations

Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021

Ramón Martinez et al. Lancet Reg Health Am. .

Abstract

Background: Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021.

Methods: Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends.

Findings: In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends.

Interpretation: Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend.

Funding: There was no funding source for this study.

Keywords: Americas; Burden of diseases; Intracerebral hemorrhage; Ischemic stroke; Stroke; Subarachnoid hemorrhage.

PubMed Disclaimer

Conflict of interest statement

CA: received honoraria as Speaker from Boehringer Ingelheim; TFA: received honoraria as Speaker from Boehringer Ingelheim; PA: received honoraria as Speaker from Boehringer Ingelheim, Abbott, Ipsen, Boston Scientific and Knigth therapeutics; CSA: Receives Grants and fellowship from the National Health and Medical Research Council (NHMRC) of Australia, Medical Research Foundation of the UK, Consulting fees as Advisory Board for AstraZeneca Australia, is the Vice-President of the World Stroke Organisation and the Editor-in-Chief of Cerebrovascular Diseases journal; MAB: received honoraria as Speaker from Roche and Boehringer Ingelheim; HB: Received payment or honoraria for lectures, presentations from Novartis and Adium Colombia; ACS: Received speaker fees from Boehringer Ingelheim; PML: Received Research grant from Boehringer-Ingelheim, payment as part of Steering Committee from Johnson & Johnson and Advisory Board from Bristol Meyer Squib and Pfizer, honoraria for lectures from Pfizer, Angels educational events from Boehringer Ingelheim, Support for attending meetings and/or travel from the Iberoamerican Stroke Society and Global Stroke Initiative, President of the Chilean Stroke Association (ACEVE) and Vice-president of the Iberoamerican stroke society (SIECV); BO: Editor-in-Chief, Journal of the American Heart Association, President, Society for Equity Neuroscience, Member, World Stroke Organization Board; OPN: Received speaker fees from Boehringer-Ingelheim and Astra-Zeneca; GSS: Received grant from the Brazilian Ministry of Health, Consulting fees from Astrazeneca and Bayer, Payment or honoraria for lectures from Astrazeneca, Bard, Support for attending meetings from Boehringer Ingelheim; SS: Received Grant from NIH Grant support; VU: Received Grant from Genentech, Inc; SA: Received payment or honoraria from Astra Zeneca and Silanes, Support for attending meetings from Astra Zeneca and Raffo, Participation on a Data Safety Monitoring Board from Astra Zeneca, VCN: Received payment or honoraria from Boehringer Ingelheim, AstraZeneca and Sanofi, Support for attending Meetings from Boehringer Ingelheim, LAC: Reveived grant from World Stroke Organization, Consulting fees from Allm Inc, IschemaView, AstraZeneca, Payment or honoraria for lectures from AstraZeneca, Boehringer Ingelheim, IschemaView, Support for attending Meetings from Boehringer Ingelheim, IschemaView, PMV: Received Research grants from ANID Fondecyt Regular 1221837 and Pfizer Research grant 76883481, Grant from Boehringer Ingelheim; AR: Participation on a Data Safety Monitoring Board or Advisory Board from Boston Scientific, Astra Zeneca, Shionogi, Brainomix, Chiesi. All other authors declare no conflicts of interest with the content of this manuscript.

Figures

Fig. 1
Fig. 1
Leading 15 Level 3 causes of death ranked by age-standardized death rates per 100 000 population for both sexes combined in the Region of the Americas 2010, 2019, 2020, and 2021. Footnotes: Among the 15 leading Level 3 causes of death, stroke is highlighted by the thicker border in the text box. Each cause is color coded by the corresponding GBD Level 1 groups of causes as informed in the legend. GBD = Global Burden of Disease study.
Fig. 2
Fig. 2
Age-standardized rates of incidence, prevalence, deaths, DALYs, YLLs, and YLDs caused by stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in both sexes combined in the Region of the Americas, 1990–2021. Footnotes: Red line represents the temporal trend of mean estimates, and the pink band represent the 95% uncertainty intervals of the mean estimate. DALYs = Disability-Adjusted Life Years, YLDs = Years Lived with Disability, YLLs = Years of Life Lost.
Fig. 3
Fig. 3
Average annual percent change for period 1990–2021 of the age-specific incidence, prevalence, mortality and DALY rates per 100 000 population caused by stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage by age group and sex in the Region of the Americas. Footnotes: Short horizontal dashes represent the mean estimates of the average annual percent change (AAPC) for each outcome. The vertical line represents the 95% confidence interval of the estimated mean AAPC. The color in the marks informs the trend as red for increasing trends, gray for constant trends, and blue for decreasing trends.
Fig. 4
Fig. 4
Average annual percent change for period 2015–2021 of the age-specific incidence, prevalence, mortality and DALY rates per 100 000 population caused by stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage by age group and sex in the Region of the Americas. Footnotes: Short horizontal dashes represent the mean estimates of the average annual percent change (AAPC) for each outcome. The vertical line represents the 95% confidence interval of the estimated mean AAPC. The color in the marks informs the trend as red for increasing trends, gray for constant trends, and blue for decreasing trends.
Fig. 5
Fig. 5
Age-standardized incidence, mortality and DALY rates from stroke and stroke subtypes in 2021, and their average annual percentage change in the period 2015–2021 across 38 countries and territories of the Americas. Footnotes: Each circle represents a country, whose size is proportional to the country’s total population in 2021, and the circle’s color represents the country’s socio-demographic index (SDI) quintile in 2021. Each country is labeled with the ISO 3166 three-letter (alpha-3) country code. The horizontal dashed line represents the 75th percentile or upper quartile of the outcome rate distribution, and the vertical dashed line represents the zero value of the average annual percentage change (AAPC).
Fig. 6
Fig. 6
Average annual percentage change during 2015–2021 of age-specific ischemic stroke mortality rates in people aged 15–49 years and 50–74 years across countries. Footnotes: Countries are sorted in descending order of the average annual percent change (AAPC) for the period 2015–2021 of the age-standardized mortality rate per 100 000 population. The dot represents the point estimates of the AAPC and the horizontal line represents the AAPC 95% credible interval. Footnotes: DALYs = Disability-adjusted life years, YLDs = Years lived with disability, YLLs = Years of life lost due to premature mortality. Figures marked in bold-red indicates an increasing trend, while those marked in bold-black indicates constant trend.
See this image and copyright information in PMC

References

    1. Feigin V.L., Stark B.A., Johnson C.O., et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):1–26. doi: 10.1016/S1474-4422(21)00252-0. - DOI - PMC - PubMed
    1. Martinez R., Lloyd-Sherlock P., Soliz P., et al. Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990–2017: a population-based study. Lancet Glob Health. 2020;8(4):e511–e523. doi: 10.1016/S2214-109X(20)30035-8. - DOI - PubMed
    1. United Nations Transforming our world: the 2030 agenda for sustainable development. Department of Economic and Social Affairs. United Nations. https://sdgs.un.org/2030agenda
    1. World Health Organization . Global action plan for the prevention and control of noncommunicable diseases, 2013-2020. 2013. p. 103.
    1. World Health Organization . 2022. Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases: annex 1. Published online. - DOI

LinkOut - more resources