Stroke is the second leading cause of death and a major cause of disability worldwide.[9]GBD 2019 Stroke Collaborators. 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 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
In 2019, a total of 3.29 million people died worldwide as a result of ischemic stroke.[9]GBD 2019 Stroke Collaborators. 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 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
There are approximately 795,000 new and recurrent strokes per year in the US, where it is the fifth leading cause of death and a major cause of disability.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
Ischemic stroke accounts for 87% of all stroke cases in the US, hemorrhagic stroke for 10%, and subarachnoid hemorrhage for 3%.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
Ischemic stroke prevalence can be further subdivided according to pathophysiologic mechanism: extracranial atherosclerosis (10%), intracranial atherosclerosis (10%), cardioembolic (25%), lacunar infarction ([small vessel disease] 15%), undetermined etiology ([i.e., cryptogenic; embolic stroke of unknown source] 30%), or other defined causes (10%).
Overall, ischemic stroke is more common in older people, males, people with lower levels of education, and African-American and Latino/Hispanic people.[11]Tsao CW, Aday AW, Almarzooq ZI, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023 Feb 21;147(8):e93-621.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001123
http://www.ncbi.nlm.nih.gov/pubmed/36695182?tool=bestpractice.com
[12]Gardener H, Sacco RL, Rundek T, et al. Race and ethnic disparities in stroke incidence in the Northern Manhattan Study. Stroke. 2020 Apr;51(4):1064-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093213
http://www.ncbi.nlm.nih.gov/pubmed/32078475?tool=bestpractice.com
[13]Howard G, Moy CS, Howard VJ, McClure LA, et al. Where to focus efforts to reduce the Black-White disparity in stroke mortality: incidence versus case fatality? Stroke. 2016 Jul;47(7):1893-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927373
http://www.ncbi.nlm.nih.gov/pubmed/27256672?tool=bestpractice.com
[14]Xiuyun W, Qian W, Minjun X, et al. Education and stroke: evidence from epidemiology and Mendelian randomization study. Sci Rep. 2020 Dec 3;10(1):21208.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713498
http://www.ncbi.nlm.nih.gov/pubmed/33273579?tool=bestpractice.com
[15]Cruz-Flores S, Rabinstein A, Biller J, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Jul;42(7):2091-116.
https://www.ahajournals.org/doi/full/10.1161/STR.0b013e3182213e24
http://www.ncbi.nlm.nih.gov/pubmed/21617147?tool=bestpractice.com
However, rates of cerebral venous thrombosis are highest in younger women, with both oral contraception and pregnancy/puerperium being major risk factors.[8]Saposnik G, Bushnell C, Coutinho JM, et al. Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. Stroke. 2024 Mar;55(3):e77-90.
https://www.ahajournals.org/doi/10.1161/STR.0000000000000456
http://www.ncbi.nlm.nih.gov/pubmed/38284265?tool=bestpractice.com
[16]Khan M, Arauz A, Uluduz D, et al. Predictors of mortality and functional outcome in pregnancy and puerperium-related cerebral venous thrombosis. Cerebrovasc Dis. 2023;52(4):393-400.
https://karger.com/ced/article-abstract/52/4/393/836333/Predictors-of-Mortality-and-Functional-Outcome-in?redirectedFrom=fulltext
http://www.ncbi.nlm.nih.gov/pubmed/36566747?tool=bestpractice.com
[17]Kashkoush AI, Ma H, Agarwal N, et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci. 2017 May;39:9-15.
https://www.doi.org/10.1016/j.jocn.2017.02.046
http://www.ncbi.nlm.nih.gov/pubmed/28274514?tool=bestpractice.com
Both the overall age-standardized incidence of stroke and stroke mortality have been decreasing over the last few decades in high-income countries, presumably due to effective primary prevention and improved management during the acute phase of stroke, although there is some evidence of increasing incidence among young adults.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
[18]Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018 Sep;17(9):790-801.
http://www.ncbi.nlm.nih.gov/pubmed/30129475?tool=bestpractice.com
[19]Seminog OO, Scarborough P, Wright FL, et al. Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. BMJ. 2019 May 22;365:l1778.
https://www.bmj.com/content/365/bmj.l1778.long
http://www.ncbi.nlm.nih.gov/pubmed/31122927?tool=bestpractice.com
[20]Lanas F, Seron P. Facing the stroke burden worldwide. Lancet Glob Health. 2021 Mar;9(3):e235-6.
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30520-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33422188?tool=bestpractice.com
In contrast, stroke incidence and mortality in low- and middle-income countries has increased.[21]Pandian JD, Gall SL, Kate MP, et al. Prevention of stroke: a global perspective. Lancet. 2018 Oct 6;392(10154):1269-78.
http://www.ncbi.nlm.nih.gov/pubmed/30319114?tool=bestpractice.com
[22]Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017 Feb 21;135(8):759-71.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.025250
http://www.ncbi.nlm.nih.gov/pubmed/28052979?tool=bestpractice.com
[23]Ezejimofor MC, Chen YF, Kandala NB, et al. Stroke survivors in low- and middle-income countries: a meta-analysis of prevalence and secular trends. J Neurol Sci. 2016 May 15;364:68-76.
https://www.jns-journal.com/article/S0022-510X(16)30148-4/abstract
http://www.ncbi.nlm.nih.gov/pubmed/27084220?tool=bestpractice.com
In 2019, the age-standardized stroke-related mortality rate was 3.6 times higher in the World Bank low-income group than in the World Bank high-income group.[9]GBD 2019 Stroke Collaborators. 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 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
In 2021, Oceania and Southeast and Central Asia had the highest rates of overall stroke mortality.[9]GBD 2019 Stroke Collaborators. 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 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
Stroke is the leading cause of death in China.[22]Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017 Feb 21;135(8):759-71.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.025250
http://www.ncbi.nlm.nih.gov/pubmed/28052979?tool=bestpractice.com