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Written by Zhang Ruijie, edited by Wang Sizhen, edited by Fang Yiyi—Xia Ye
The Global Burden of Disease Study shows that stroke is the second leading cause of disease worldwide, with ischemic stroke being the most common subtype of stroke [1-2].
Although stroke is common in older people, there is growing evidence of an increased incidence of stroke in young adults, particularly in low- and middle-income countries [3-4].
Due to the sequelae of stroke and the reduction of life expectancy, stroke in young adults is more likely to cause a heavy burden on the economy, family and society [5-7].
In addition, stroke risk factors are more complex in young adults than in older adults, and there are relatively few
guidelines for stroke prevention in young adults.
Currently, there is a lack of evidence for a systematic assessment of the incidence of ischaemic stroke (DALY) in young adults by regional, national and sociodemographic development indices (SDIs).
Understanding the prevalence pattern of ischemic stroke in young adults and the attributing factors of disease burden will help to formulate corresponding prevention guidelines and improve the primary prevention strategy of ischemic stroke in young adults, which has important public health significance
for the prevention and control of stroke in young adults.
Recently, Professor Han Liyuan's research group of Professor Han Liyuan's Global Health Research Center of Ningbo Huamei Hospital of the University of Chinese Academy of Sciences and Ningbo Life and Health Industry Research Institute published a report entitled "Global Burden of Ischemic Stroke in Young Adults in 204 Countries and" in Neurology Territories' latest research (Online ahead of print) reveals the incidence, mortality and DALY of ischemic stroke in young adults from 1990 to 2019 The status and trend of ADLY in ischemic stroke in young adults due to different risk factors were estimated
.
1 Global burden of disease in ischemic stroke in young adults
In 2019, the global age-standardized incidence of ischemic stroke in young adults was 21.84, the age-standardized mortality rate was 1.
34/100,000, and the age-standardized DALY rate was 117.
58/10 10,000 people, the standardized incidence, mortality and DALY rate of stroke among young adults worldwide from 1990 to 2019 showed a downward trend (Figure 1).
。
Figure 1 Percentage annual change in age-standardized morbidity, mortality and DALY rates by sex (EAPC) at global, SDI regional and regional levels, 1990-2019
(Source: Zhang R, et al.
, Neurology.
2022).
2.
Disease burden of ischemic stroke in different SDI regions
63/100,000) and in the high SDI area (18.
20/100,000).
) lowest (Figure 2).
From 1990 to 2019, the largest increase in age-standardized incidence occurred in areas with low and moderate SDI and the greatest decline in areas with high SDI (Figure 1, Figure 2).
The highest age-standardized mortality rate in 2019 was in areas with moderate SDI (1.
63 per 100,000) and lowest in high SDI settings (0.
55 per 100,000) (Figure 2).
Between 1990 and 2019, age-standardized mortality increased in low SDI settings and decreased in other SDI settings over the same period (Figure 1, Figure 2).
In 2019, the highest age-standardized DALY rates were in the middle SDI region (135.
85 per 100,000) and the lowest in the high SDI region ( 75.
25/100,000) (Figure 2).
Between 1990 and 2019, the rate of age-standardized DALY increased the most in low SDI settings, followed by low and intermediate SDI settings (EAPC = 0.
07) (Figure 1, Figure 2).
Fig.
2 Age-standardized morbidity, mortality and DALY rates of stroke among young adults in different SDI regions from 1990 to 2019
(Source: Zhang R, et al.
, Neurology.
2022).
3.
Regional and national burden of disease in ischemic stroke in young adults
36 per 100 000), Eastern Europe (32.
67 per 100 000), and the Caribbean ( 30.
65/100,000).
The regions with the lowest age-standardized prevalence were Western Europe (11.
50 per 100 000), Australasia (13.
65 per 100 000), and Southern Latin America (14.
59 per 100 000) (Figure).
3）
。 The regions with the fastest increase in age-standardized incidence are South-East Asia, Oceania, and North Africa and the Middle East (Figures 1, 4).
In contrast, the largest declines were in tropical Latin America, Central Latin America and Central Europe
.
Among 204 countries, Libya, Egypt, and Afghanistan had the fastest increases in age-standardized incidence (Figure 4).
The regions with the highest age-standardized mortality rates from ischaemic stroke in young adults in 2019 were North Africa and the Middle East (3.
31 per 100 000), Eastern Europe (2.
83 per 100 000), and Central Asia (2.
58 per 10 000).
The regions with the lowest age-standardized mortality rates were Western Europe (0.
22 per 100 000), Australasia (0.
15 per 100 000), and high-income North America (0.
28 per 100 000) (Figure 3
。 The regions with the fastest growth in age-standardized mortality are South-East Asia, Oceania, North Africa and the Middle East
.
In contrast, tropical Latin America, high-income Asia-Pacific, and Western Europe experienced the largest declines (Figures 1, 4).
Of the 204 countries, the three countries with the fastest increases in age-standardized mortality between 1990 and 2019 were the Philippines, Zimbabwe, and Lesotho (Figure 4
。
The regions with the highest age-standardized DALY rates of ischemic stroke in young adults in 2019 were North Africa and the Middle East (228.
11 per 100 000), Eastern Europe (205.
85 per 100 000), and Central Asia ( 182.
10/100,000).
The regions with the lowest age-standardized DALY rates were Western Europe (41.
77 per 100 000), Southern Latin America (46.
28 per 100 000) and Australasia (42.
05 per 100 000) (Figure 3).
The regions with the fastest growth in age-standardized DALY rates are high-income North America, Southeast Asia, North Africa, and the Middle East (Figures 1, 4).
In contrast, tropical Latin America and Western and Central Europe experienced the largest
declines.
Of the 204 countries, the countries with the largest increases in age-standardized DALY rates between 1990 and 2019 were the Philippines, Libya and Egypt (Figure 4).
Fig.
3 Age-standardized morbidity, mortality and DALY rate of ischemic stroke in young adults in 2019 (/100,000).
(Source: Zhang R, et al.
, Neurology.
2022).
Fig.
4 Age-standardized morbidity, mortality and DALY rate EAPC of ischemic stroke in young adults from 1990 to 2019
(Source: Zhang R, et al.
, Neurology.
2022).
4.
Analysis of attribution risk factors for ischemic stroke in young adults in global and SDI regions
37% of the total DALYs for ischemic stroke in young adults in 2019 were attributed to the risk factors
listed in the GBD 2019 dataset.
The total DALY attributed to risk factors in the GBD 2019 dataset increased from 2692193.
1 in 1990 to 2019 4110603.
28
.
Environmental/occupational, behavioral and metabolic risk factors accounted for 45.
25%, 59.
75% and 69.
92% of the total DALY, respectively
。 In terms of specific risk factors, the highest rates of age-standardized DALY in 2019 were high low-density lipoprotein (LDL), followed by high systolic blood pressure and high body mass index (BMI)
。 Between 1990 and 2019, the rate of age-standardized DALY increased most due to high ambient temperature, high BMI, and high fasting blood glucose (Figure 5）
。
From 1990 to 2019, age-standardized DALY rates attributed to alcohol use increased the fastest in areas with low SDI, while high SDI was moderately high The SDI and middle SDI regions saw the fastest increase in DALY rates due to high ambient temperatures (Figure 5).
。
Fig.
5 Age-standardized DALY rates of stroke in young adults attributed to risk factors in 1990 and 2019 and trends between 1990 and 2019 .
(Source: Zhang R, et al.
, Neurology.
2022).
Although age-standardized morbidity, mortality, and DALY rates of ischaemic stroke in young adults declined globally between 1990 and 2019, in low- and middle- and low-SDI regions such as North Africa, the Middle East and Southeast Asia, The burden of ischaemic stroke is still increasing
.
Globally, age-standardized DALY rates increased the most
due to high ambient temperature, high BMI, and high fasting blood glucose.
The attribution risk factors of young adults in different SDI regions were different
.
Targeted implementation of cost-effective policies and interventions is an urgent need
to reduce the burden of ischaemic stroke among young adults.
The study had certain limitations: First, the quality of data in less developed countries compared to other regions was poor due to the lack of comprehensive chronic disease surveillance systems and accurate diagnostic techniques
.
Second, we cannot assess the contribution
of medical technology developments, such as medical imaging, to ischaemic stroke morbidity and mortality in low- and middle-income settings.
Third, the biggest challenge in estimating the attributable burden in GBD research is the availability and quality
of primary data across regions.
Fourth, further research is needed to validate the dose-response relationship
of specific risk factors on outcomes.
Original link: https://pubmed.
ncbi.
nlm.
nih.
gov/36307222/
Zhang Ruijie's research intern is the first author of the paper, and Professor Han Liyuan is the corresponding author of the paper, which is supported by the National Natural Science Foundation of China, Zhejiang Public Welfare Technology Application Research, Zhejiang Medical and Health Science and Technology Program, Ningbo Public Welfare Science and Technology Program and other funds
.
Han Liyuan, Director of the Center for Public Health and Global Health, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, doctoral supervisor, Ningbo Top Talent Level 2
.
His research focuses on cardiovascular and cerebrovascular disease epidemiology and translational medicine
.
The team has a wealth of resources, including the high-quality "Hypertensive Stroke Prospective Research Cohort", "The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS)", etc.
Participated in the Chinese Academy of Sciences' Strategic Leading Technology B Plan "Multi-dimensional Big Data-driven Chinese Group Precision Health Research", which mainly builds the eastern center of China's natural population biobank and builds a project for precision health research and data sharing.
" National Resource Bank of Natural Populations in China"
.
In the past 5 years, he has published more than 50 SCI papers, and has published more than 50 SCI papers in foreign journals such as Neurology and The Lancet Regional Health , Lancet Child and Adolescent Health, Stroke, JAMA Network Open and other journals have published papers, His research results on the correlation between homocysteine and ischemic stroke have been written into the Chinese Stroke Prevention and Treatment Guidelines (2021 Edition).
As the first inventor, he has obtained 3 invention patents, 1 software copyright and 2 utility model patents
.
He has presided over 15 projects such as the National Natural Science Foundation of China, the Youth Project, the Sub-project of the Key R&D Program of the Ministry of Science and Technology, the Special Grant and General Grant of the China Postdoctoral Fund, the Natural Science Foundation of Zhejiang Province and the Youth Fund, the Zhejiang Provincial Public Welfare Fund, and the Ningbo Natural Science Foundation
.
HE IS THE CHIEF EDITOR OF "PRACTICAL CLINICAL EPIDEMIOLOGY", THE ASSOCIATE EDITOR OF "EPIIDEMIOLOGY", AND PARTICIPATED IN THE EDITING OF "MEDICAL STATISTICS" AND "PREVENTIVE MEDICINE"
。 He has won the second and third prizes of Ningbo Science and Technology Progress Award, the excellent worker of the Chinese Stroke Society, and the third prize of Si Nan of the 100 Excellent Papers on the Prevention and Treatment of Stroke in China
.
Welcome to scan the code to join Logical Neuroscience Literature Study 2
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Recommended high-quality scientific research training courses [1] The 10th NIR Training Camp (online: 2022.11.
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24) Welcome to join "Logical Neuroscience" [1] " Logical Neuroscience " Recruitment Editor/Operation Position ( Online Office [2] Talent Recruitment - "Logical Neuroscience" Recruitment Article Interpretation/Writing Position ( Online Part-time, Online Office) References (swipe up and down to read).
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Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.
Lancet.
2020; 396:1204–1222.
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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; 20:1–26.
[3] Singhal AB, Biller J, Elkind MS, et al.
Recognition and management of stroke in young adults and adolescents.
Neurology.
2013; 81:1089–1097.
[4] Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM.
Ischaemic stroke in young adults: A global perspective.
J Neurol Neurosurg Psychiatry.
2020; 91:411–417.
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Stroke in young adults: Current trends, opportunities for prevention and pathways forward.
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The Growing Problem of Stroke among Young Adults.
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[7] Ekker MS, Boot EM, Singhal AB, et al.
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2018; 17:790–801.
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