The number of stroke deaths worldwide is set to climb 50% to nearly 10 million by 2050, with most cases occurring in low- and middle-income countries, according to a new wide-ranging report from the World Stroke Organization-Lancet Neurology Commission.
The paper also projected that strokes will cause more disability worldwide, estimating that disability-adjusted life-years — the years of life lost and years living with stroke-induced disability — will grow about 30% to reach 190 million by 2050.
The economic toll of these increases will be enormous. The costs of strokes — including healthcare expenses and lost income from sickness — is forecasted to more than double to $2 trillion per year, according to the report, published Monday in the journal Lancet Neurology.
These projections underscore the severe burden of strokes worldwide and highlight gaps in the prevention and treatment of the condition, particularly in low- and middle-income countries. The paper comes soon after the World Health Organization released a report showing that high blood pressure, a key risk factor for strokes, is inadequately treated worldwide.
“People are dying from stroke, a disease that can be prevented and treated,” Sheila Martins, president of the World Stroke Organization, said in an interview. “Really, we need to start now to do something.”
Income makes a huge difference in stroke prevention. Advances in medicines to address risk factors like hypertension and high cholesterol, as well as technologies to treat strokes, have helped drive down stroke rates in wealthier countries, but many poorer countries lack widespread access to those resources.
Even though the rate of stroke deaths is expected to decline globally, the absolute number of deaths is set to increase in poorer countries, the Lancet report said. By 2050, stroke deaths in low- and middle-income countries are set to make up 91% of stroke deaths worldwide. In particular, deaths in the region of southeast Asia, east Asia and Oceania are projected to account for 51% of deaths globally.
The report noted that growing levels of diabetes and obesity among younger people could affect stroke rates in that age group. While the global rate of stroke deaths among people over 60 is estimated to fall 36% by 2050, the rate is predicted to decline less, by 25%, for people under 60.
The authors identified four areas for countries and policymakers to focus on — surveillance of strokes and associated risk factors, prevention of strokes both for people who have never experienced them and for people who have, timely treatment of strokes in the acute stage, and rehabilitation for people who have experienced strokes.
Many low- and middle-income countries lack infrastructure, training and treatments in these four areas, the report said.
For example, researchers found that only 31 of the 216 WHO member countries are conducting sufficient stroke surveillance through national record-keeping, and all but seven of the 31 countries are high-income. The researchers found no national registries in the regions of north Africa and the Middle East and sub-Saharan Africa.
Moreover, researchers found that stroke units were available in 91% of hospitals surveyed in high-income countries, compared with 18% of hospitals surveyed in low-income countries.
“The paper is to convince the policymakers and other stakeholders that it is important to organize stroke care,” Martins said. “We need to work at the country level to really make a difference.”