Socioeconomic Status and Stroke Incidence, Prevalence, Mortality and Worldwide Burden: An Ecological Analysis from the Global Burden of Disease Study ۲۰۱۷

Background and Aim: Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. Materials and Methods: We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) ۲۰۱۷. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from ۱۹۹۰ to ۲۰۱۷. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from ۱۹۹۰ to ۲۰۱۷. Results: Despite a growth in crude number of stroke events from ۱۹۹۰ to ۲۰۱۷, there has been an ۱۱.۳% decrease in age-standardised stroke incidence rate worldwide (۱۵۰.۵, ۹۵% uncertainty interval [UI] ۱۴۰.۳–۱۶۱.۸ per ۱۰۰,۰۰۰ in ۲۰۱۷). This has been accompanied by an overall ۳.۱% increase in age-standardised stroke prevalence rate (۱۳۰۰.۶, UI ۱۲۲۹.۰–۱۳۷۴.۷ per ۱۰۰,۰۰۰ in ۲۰۱۷), and a ۳۳.۴% decrease in age-standardised stroke mortality rate (۸۰.۵, UI ۷۸.۹–۸۲.۶ per ۱۰۰,۰۰۰ in ۲۰۱۷) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since ۲۰۰۵. Further, there has been almost a ۳۴% reduction in stroke death rate (۶۷.۸, UI ۶۴.۱–۷۱.۱ per ۱۰۰,۰۰۰ in ۲۰۱۷) attributable to modifiable risk factors, more prominently in wealthier countries. Conclusion: Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden, thus screening of people from low SES at higher stroke risk is crucial.

Keywords:

Global burden of disease , Socioeconomic factors , Stroke