Comparative analysis of stroke burden between ages 20-54 and over 55 years: based on the global burden of disease
Zhuoxi Wang1,2, Yiqing Liu1, Rui Qie3
1Experimental Research Center, China Academy of Chinese Medical Sciences, 16 Dongzhimennei South Xiaojie, Dongcheng District, Beijing, China.
Insights
Stroke burden is rising in younger adults (20-54), especially ischemic stroke (IS), while decreasing in older adults (>55). Risk factors like high blood pressure, BMI, and blood glucose contribute differently across age groups.
Area of Science:
- Epidemiology
- Global Health
- Public Health
Background:
- Stroke is a leading global cause of death and disability.
- Investigating stroke burden across different age demographics is crucial for public health strategies.
Purpose of the Study:
- To analyze trends in stroke burden (incidence, DALYs, mortality, prevalence) for intracranial haemorrhage (ICH), subarachnoid haemorrhage (SAH), and ischaemic stroke (IS).
- To compare stroke burden between younger adults (20-54 years) and older adults (>55 years) from 1990 to 2019.
- To identify epidemiological factors influencing stroke burden and health inequalities.
Main Methods:
- Utilized Global Burden of Disease Study 2019 data.
- Calculated age-specific incidence, DALYs, mortality, and prevalence rates.
- Employed Joinpoint regression, decomposition analysis, and health inequality analysis.
Main Results:
- Global incidence of ICH and SAH decreased in the 20-54 age group, but IS incidence increased.
- Stroke incidence showed an overall decreasing trend in the >55 age group.
- Mortality and DALYs decreased less for IS compared to ICH and SAH, and declines were greater in the >55 group.
- Prevalence of all stroke types increased in the 20-54 group, with a mild increase in IS for the >55 group.
- Stroke burden correlated negatively with regional development.
- High systolic blood pressure was a common risk factor; high BMI affected younger adults more, while abnormal fasting blood glucose affected older adults more.
Conclusions:
- Stroke burden in the 20-54 age group is a growing global health concern.
- Ischaemic stroke incidence in lower economic development areas is particularly concerning.
- Targeted public health interventions are needed to address age-specific stroke risks and disparities.
Background:
Stroke remains one of the major diseases threatening human health and life worldwide. Therefore, it is urgent to investigate the stroke burden in different age groups.
Methods:
We described the disease burden of three subtypes of stroke, namely intracranial haemorrhage (ICH), subarachnoid haemorrhage (SAH), and ischaemic stroke (IS), among people aged 20 ~ 54 years and > 55 years from 1990 to 2019, based on data from Global Burden of Disease Study 2019 and calculated the estimated annual percentage changes (EAPC) for age-specific incidence, disability-adjusted life-years (DALYs), mortality and prevalence rates. Joinpoint regression analyzes showed the critical years of trend inflexion points. Decomposition and health inequality analyses determined the impact of different epidemiological factors on stroke burden. Population-attributable fractions were calculated for deaths and DALYs due to risk factors.
Results:
From 1990 to 2019, the incidence of ICH and SAH decreased by 11.32% and 10.45%, respectively, in the 20-54 age group globally, while the incidence of IS increased by 14.95%. Meanwhile, the incidence of stroke in the > 55 years group showed an overall decreasing trend. The burden of adverse outcomes, including death and DALYs, varied by stroke subtype, with the rates of mortality and DALYs decreasing significantly less in IS than in ICH and SAH. In addition, the decline in mortality and DALYs rates was consistently greater in the over 55 years age group than in the 20-54 years age group. Notably, the prevalence of ICH, SAH, and IS increased by 20.55%, 11.50%, and 7.38% in the 20-54 years age grouper group, respectively, whereas in the elderly group, there was only a mild increase of IS in the over 55 years group. What is more, stroke burden showed a negative correlation with regional development. Furthermore, high systolic blood pressure was a common contributor to stroke burden in both age groups. The difference is that a high body mass index affects people aged 20-54 years more, while abnormal fasting blood glucose affects older people more.
Conclusion:
The stroke burden in people 20-54 years of age is increasingly becoming a global health problem, particularly the incidence of IS in lower economic development areas.
Clinical Trial Number:
Not applicable.
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