Stroke could cause nearly 10 million deaths annually by 2050, report warns

Epidemiological analysis projects stroke deaths will increase from 6.6 million in 2020 to 9.7 million in 2050, with an ever-widening gap between low- and middle-income countries and high-income countries

The number of people who die from stroke globally is estimated to increase by 50 per cent by 2050 to 9.7 million deaths per year unless urgent action is taken, a new report claims.

The New World Stroke Organisation-Lancet Neurology Commission, published in Lancet Neurology, also estimated annual costs as high as US$2.3 trillion. The authors’ analysis forecasts growing health and economic impacts from stroke between 2020 and 2050, which will disproportionately affect low and middle-income countries (LMIC).

Professor Valery L. Feigin, of Auckland University of Technology, New Zealand and Commission co-chair, said: “Stroke exerts an enormous toll on the world’s population, leading to the death and permanent disability of millions of people each year and costing billions of dollars.

“Precisely forecasting the health and economic impacts of stroke decades into the future is inherently challenging given the levels of uncertainty involved, but these estimates are indicative of the ever-increasing burden we will see in the years ahead unless urgent, effective action is taken.”

The number of people who suffer a stroke globally has almost doubled over the past 30 years, with the vast majority of those affected in LMICs, where the prevalence of the condition is increasing at a faster rate than in high-income countries (HICs).

Professor Jeyaraj Pandian, president-elect of the World Stroke Organisation, one of the lead authors of the Commission, said: “Asia accounted for by far the greatest share of global stroke deaths in 2020 […] and this is forecast to rise to around 69 per cent by 2050; around 6.6 million deaths.

“Though smaller relative to Asia, the number of annual global stroke deaths occurring in Sub-Saharan African countries will rise from 6 per cent in 2020 to 8 per cent in 2050. We have to closely examine what is causing this increase, including the growing burden of uncontrolled risk factors – especially high blood pressure and lack of stroke prevention and care services in these regions.

Without urgent action, stroke deaths in Southeast Asia, East Asia and Oceania could increase by almost 2 million deaths, from 3.1 million in 2020 to potentially 4.9 million in 2050.”

If the current trends continue, one of the World Health Organisation’s key Sustainable Development Goals (SDGs) will not be met. SDG 3.4 aims to reduce the 41 million premature deaths from non-communicable diseases – including stroke – by one-third by 2030. While achieving these would require US$140 billion in new spending between 2023 and 2030, the financial benefits would outweigh the costs by ten-to-one, the report states.

“Every member State of the United Nations has committed to meeting the SDGs but at present few countries are on target to achieve SDG 3.4,” said professor Mayowa O. Owolabi, of the University of Ibadan, Nigeria and Commission co-chair.

Based on a review of evidence-based guidelines, recent surveys and in-depth interviews with stroke experts around the world, the authors make recommendations to reduce the global burden, including measures to improve stroke surveillance, prevention, acute care and rehabilitation.

Professor Owolabi added: “Stroke is countable, substantially preventable, treatable and beatable through the pragmatic solutions recommended by this Commission across the four pillars of the stroke quadrangle (surveillance, prevention, acute care, and rehabilitation).

“By implementing and monitoring all of the Commission’s recommendations, which have a firm evidence base, the global burden of stroke will be reduced drastically this decade and beyond. Not only will this enable us to meet SDG 3.4, as well as other key SDGs, it will improve brain health and the overall wellbeing of millions of people across the globe now and beyond 2030.”

To identify key barriers and facilitators to high-quality stroke surveillance, prevention, acute care and rehabilitation, the Commission authors conducted a qualitative analysis of in-depth interviews with 12 stroke experts from six HICs and six LMICs.

Among the major barriers identified were low awareness of stroke and its risk factors (which include high blood pressure, diabetes mellitus, high cholesterol, obesity, unhealthy diet, sedentary lifestyle, and smoking), and limited surveillance data on stroke risk factors, events, management, and outcomes of stroke. Major facilitators included well-developed stroke organisations and networks that can build capacity for stroke care and research, and universal healthcare providing population-wide access to evidence-based stroke care.

Based on the findings of the qualitative analysis, the Commission authors made 12  recommendations across stroke surveillance, prevention, acute care and rehabilitation. .

“One of the most common problems in implementing stroke prevention and care recommendations is the lack of funding,” said professor Feigin. “Our Commission recommends introducing legislative regulations and taxations of unhealthy products such as salt, alcohol, sugary drinks [and] trans-fats by each and every government in the world.

“Such taxation would not only reduce consumption of these products – and therefore lead to the reduction of burden from stroke and major other non-communicable diseases – but also generate a large revenue sufficient to fund not only prevention programmes and services for stroke and other major disorders but also reduce poverty, inequality in health service provision and improve wellbeing of the population.”

“Investing in evidence-based measures to reduce the global burden of stroke will deliver benefits that go far beyond health alone. As well as delivering health and economic benefits relating to stroke, many of our recommendations would also facilitate reductions in poverty and inequality and boost local economies.”