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Atlas
Neuroepidemiology 2015;45:230–236
DOI: 10.1159/000441106
Atlas of the Global Burden of Stroke
(1990–2013): The GBD 2013 Study
ValeryL.Feigin a GeorgeA.Mensah d BoNorrving b ChristopherJ.L.Murray c
GregoryA.Roth c GBD 2013 Stroke Panel Experts Group
a FAAN, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland ,
New Zealand;
b Department of Clinical Sciences, Neurology, Lund University, Lund , Sweden;
c Institute for Health
Metrics and Evaluation and the Division of Cardiology, School of Medicine, University of Washington, Seattle, Wash. ,
d Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences; National
Heart, Lung, and Blood Institute; National Institutes of Health, Bethesda, Md. , USA
timates of global population. All estimates have been com-
puted with 95% uncertainty intervals. Results: Age-stan-
dardized incidence, mortality, prevalence and DALYs/YLDs
declined over the period from 1990 to 2013. However, the
absolute number of people affected by stroke has substan-
tially increased across all countries in the world over the
same time period, suggesting that the global stroke burden
continues to increase. There were significant geographical
(country and regional) differences in stroke burden in the
world, with the majority of the burden borne by low- and
middle-income countries. Conclusions: Global burden of
stroke has continued to increase in spite of dramatic declines
in age-standardized incidence, prevalence, mortality rates
and disability. Population growth and aging have played an
important role in the observed increase in stroke burden.
© 2015 S. Karger AG, Basel
Key Words
Stroke · Atlas · Burden · GBD 2013
Abstract
Background: World mapping is an important tool to visual-
ize stroke burden and its trends in various regions and coun-
tries. Objectives: To show geographic patterns of incidence,
prevalence, mortality, disability-adjusted life years (DALYs)
and years lived with disability (YLDs) and their trends for
ischemic stroke and hemorrhagic stroke in the world for
1990–2013. Methodology: Stroke incidence, prevalence,
mortality, DALYs and YLDs were estimated following the
general approach of the Global Burden of Disease (GBD)
2010 with several important improvements in methods.
Data were updated for mortality (through April 2014) and
stroke incidence, prevalence, case fatality and severity
through 2013. Death was estimated using an ensemble
modeling approach. A new software package, DisMod-MR
2.0, was used as part of a custom modeling process to esti-
mate YLDs. All rates were age-standardized to new GBD es-
Received: July 30, 2015
Accepted: September 15, 2015
Published online: October 28, 2015
Professor Valery L. Feigin, MD, MSc, PhD, FAAN
NISAN, AUT University, AUT North Shore Campus, AA254
90 Akoranga Dr, Northcote 0627
Auckland 1142 (New Zealand)
E-Mail valery.feigin @ aut.ac.nz
© 2015 S. Karger AG, Basel
0251–5350/15/0453–0230$39.50/0
www.karger.com/ned
Members of the GBD 2013 Stroke Panel Experts Group are listed in
the Appendix at the end of the paper.
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Atlas of the Global Burden of Stroke Neuroepidemiology 2015;45:230–236
DOI: 10.1159/000441106
231
0–170
170–339
339–508
508–677
677–846
846–1,015
1,015–1,184
Fig. 1. Age-standardized annual prevalence (per 100,000) of ischemic stroke in 2013.
0–39
39–78
78–116
116–155
155–193
193–232
232–270
Fig. 2. Age-standardized annual prevalence (per 100,000) of hemorrhagic stroke in 2013.
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Feigin etal.
Neuroepidemiology 2015;45:230–236
DOI: 10.1159/000441106
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0–25
25–50
50–75
75–100
100–124
124–149
149–174
Fig. 3. Age-standardized annual mortality rates (per 100,000) of ischemic stroke in 2013.
0–32
32–64
64–95
95–127
127–159
159–190
190–222
Fig. 4. Age-standardized annual mortality rates (per 100,000) of hemorrhagic stroke in 2013.
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Atlas of the Global Burden of Stroke Neuroepidemiology 2015;45:230–236
DOI: 10.1159/000441106
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0–358
358–715
715–1,072
1,072–1,429
1,429–1,787
1,787–2,144
2,144–2,501
Fig. 5. Age-standardized annual DALYs rates (per 100,000) due to ischemic stroke in 2013.
0–638
638–1,276
1,276–1,914
1,914–2,552
2,552–3,190
3,190–3,828
3,828–4,465
Fig. 6. Age-standardized annual DALYs rates (per 100,000) due to hemorrhagic stroke in 2013.
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Neuroepidemiology 2015;45:230–236
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–30 to –19%
–19 to –8%
–8 to 3%
3 to 14%
14 to 25%
25 to 36%
36 to 47%
–27 to –13%
–13 to 2%
2 to 16%
16 to 31%
31 to 46%
46 to 60%
60 to 75%
Fig. 7. Percent change in age-standardized prevalence due to ischemic stroke for 1990–2013.
Fig. 8. Percent change in age-standardized prevalence due to hemorrhagic stroke for 1990–2013.
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Atlas of the Global Burden of Stroke Neuroepidemiology 2015;45:230–236
DOI: 10.1159/000441106
235
–75 to –54%
–54 to –33%
–33 to –13%
–13 to 8%
8 to 29%
29 to 49%
49 to 70%
–76 to –43%
–43 to –10%
–10 to 24%
24 to 57%
57 to 90%
90 to 124%
124 to 157%
Fig. 9. Percent change in age-standardized mortality rates due to ischemic stroke for 1990–2013.
Fig. 10. Percent change in age-standardized mortality rates due to hemorrhagic stroke for 1990–2013.
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DOI: 10.1159/000441106
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Acknowledgments
This work was undertaken as a part of the Global Burden of
Diseases, Injuries, and Risk Factors (GBD 2013) study. We thank
Sarah Safranek, University of Washington Health Sciences Li-
brary, for her help in developing the systematic review literature
search strategies; Michael F. MacIntyre, Brittany Wurtz and Sum-
mer Ohno, University of Washington Institute for Health Metrics
and Evaluation, for research coordination; Ryan M. Barber, Uni-
versity of Washington Institute for Health Metrics and Evaluation,
for creating figures and tables for the paper; Hannah Gardener,
University of Miami, for helping reviewing some studies; and Hel-
en McDonald, AUT University National Institute for Stroke And
Applied Neurosciences, for organizing teleconferences and secre-
tarial support. The authors alone are responsible for the views ex-
pressed in this publication.
Role of the Funding Source
This study was funded by the Bill and Melinda Gates Founda-
tion. The sponsor of the study had no role in the study design, data
collection, data analysis, data interpretation or writing of the re-
port. The GBD 2013 Core investigators had access to all data sourc-
es and were responsible for the content of the report and the deci-
sion to submit for publication.
Disclaimer
The views expressed in this article are those of the authors and
do not necessarily represent the views of the National Heart, Lung,
and Blood Institute; National Institutes of Health, or the US De-
partment of Health and Human Services.
Disclosure Statement
The authors have no conflict of interest to declare.
Appendix
GBD 2013 Stroke Panel Experts Group (in Alphabetical Order
by Country)
Argentina (Maria Cecilia Bahit); Australia (Amanda G. Thrift,
Atte Meretoja, Bill Stavreski, Craig S. Anderson, Edwin Pearse,
Geoffrey Donnan, Graeme J. Hankey, Mark T. Mackay, Stephen
Davis, Zanfina Ademi);
Austria (Michael Brainin); Azerbaijan
(Tural Guliyev); Bahrain (Randah R. Hamadeh); Barbados (Heath-
er Harewood, Karen Springer);
Brazil (Iuri da Costa Leite, Jefferson
Gomes Fernandes, Norberto Luiz Cabral, Paulo A. Lotufo);
Bulgaria (Klara Dokova); Canada (Farshad Pourmalek, Gabrielle
DeVeber, Luciano A. Sposato, M. Patrice Lindsay, Patricia M. Ric-
cio);
Chile (Pablo M. Lavados); China (Bin Li, Chuanhua Yu, Guo-
hong Jiang, Jixiang Ma, Maigeng Zhou, Ming Liu, Shankuan Zhu,
Wenzhi Wang, Xiaofeng Liang, Yong Zhang);
Colombia (Gabriel
Alcalá-Cerra);
Denmark (Hanne K. Christensen, Thomas Tru-
elsen);
Egypt (Foad Abd-Allah); Ethiopia (Awoke Temesgen, Ber-
he Weldearegawi Sahle, Semaw Ferede Abera, Yohannes Adama
Melaku);
Fiji (Devina Nand); France (Maurice Giroud); Germany
(Jost B. Jonas, Matthias Endres, Ronny Westerman);
Greece (Kon-
stantinos Stroumpoulis); India (Dorairaj Prabhakaran, Jeyaraj Du-
rai Pandian, Man Mohan Mehndiratta, Nobhojit Roy, Panniyam-
makal Jeemon, Rajeev Gupta, Vasanthan Rajagopalan);
Indonesia
(Soewarta Kosen, Tati Suryati Warouw);
Iran (Reza Malekzadeh);
Ireland (Martin J. O’Donnell); Israel (Natan M. Bornstein, David
Tanne);
Italy (Stefano Ricci, Valeria Caso); Japan (Yoshihiro
Kokubo, Yukito Shinohara);
Jordan (Majed Masoud Asad); Kenya
(Vitalis Kizito Bwire);
Korea (Sun Ha Jee, Young-Ho Khang);
Mexico (Ismael Campos-Nonato); Malaysia (Kim Yunjin, Ramesh
Sahathevan);
Morocco (Fortuné Gankpé); Myanmar (Chaw Yin
Myint); Netherlands (Johanna M. Geleijnse); New Zealand (Priya
Parmar, Rita V. Krishnamurthi, Suzanne Barker-Collo, Valery L.
Feigin);
Nigeria (Rufus Olusola Akinyemi); Norway (Ole Norhe-
im);
Qatar (Shams Eldin Khalifa); Russia (Michael Kravchenko,
Michael Piradov, Nikolay Shalamov, Vasiliy Victorovich Vlassov,
Yuri Varakin);
Rwanda (Jean De Dieu Ngirabega, Jean Pierre Ny-
emazi, Marie Aimee Muhimpundu);
Saudi Arabia (Mohammad
Saeedi, Neeraj Bedi);
Singapore (Narayanaswamy Venketasubra-
manian);
South Africa (Andre Pascal Kengne); Spain (David
Rojas-Rueda, Ferrán Catalá-López);
Sri Lanka (Samath D. Dhar-
maratne);
Sweden (Bo Norrving, Rasmus Havmoeller); Uganda
(Leo Atwine);
United Kingdom (Amitava Banerjee, Charles Wolfe,
Derrick A. Bennett, Finbar O’Callaghan, Ivy Shiue, Julia A. Critch-
ley, Majid Ezzati, Michael Soljak, Myles D. Connor, Peter M. Roth-
well, Rajiv Chowdhury, Rustam Al-Shahi Salman, William White-
ley, Zhengming Chen);
Uruguay (Mercedes Colomar); USA (Ad-
nan M. Durrani, Anand Dayama, Andrew E. Moran, Awoke
Misganaw, Brett M. Kissela, Catherine Amlie-Lefond, Catherine O.
Johnson, Cheng Huang, Christopher J.L. Murray, Chugh Sumeet,
Daniel Kim, David K. Cundiff, David Lawrence Tirschwell, Dhruv
S. Kazi, Dima Qato, Edmond Kato Kabagambe, Eric Ding, Gene
Bukhman, Gene Kwan, George A. Mensah, George D. Thurston,
Grant Nguyen, Gregory A. Roth, Josef Coresh, Kate Lefondulq,
Kevin N. Sheth, Matthew A. Corriere, Mohammad H. Forouzanfar,
Mohsen Naghavi, Nana Mainoo, Norman J. Beauchamp, Ralph L.
Sacco, Richard F. Gillum, Sanjay Basu, Stephen M. Schwartz, Su-
meet Chugh, Teresa Fung, Theo Vos, Tim E. Byers, Uchechukwu
K.A. Sampson, Walter A. Rocca, Warren Lo).
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