As per the National Institutes of Health (NIH), the economic toll of stroke on a global scale surpasses 721 billion U.S. dollars, with the most substantial impact anticipated in low- and middle-income nations.
A recent report cautions that the worldwide fatality rate due to strokes is poised to surge by 50 percent by the year 2050. The World Health Organization (WHO) reveals that annually, 15 million individuals across the globe suffer from a stroke, resulting in approximately 5 million deaths and another 5 million enduring permanent disability.
Despite significant strides in stroke outcomes within the United States over recent decades, as evidenced by a decline in stroke-related fatalities from the third to the fifth leading cause of death, according to the Centers for Disease Control and Prevention (CDC), such progress is not uniformly distributed globally. WHO statistics indicate that since 2005, the likelihood of an individual experiencing a stroke has risen by 50 percent worldwide, establishing it as the second leading cause of death globally.
Published on October 9, 2023, in the Lancet Neurology, a new report forecasts that low- and middle-income countries will bear the brunt of the increasing stroke burden in the years ahead. Moreover, it anticipates a rise in the incidence of strokes across all age groups, including a notable increase among younger individuals, irrespective of geographical location.
“Stroke is going to be one of the main public health issues over the next 30 years,” said Salman Azhar, MD. He is the director of the stroke program at Northwell Lenox Hill Hospital. He also was not part of the report. But, “as dismal as these numbers sound, there are interventions we can do.”
Fewer Resources Go with The Growing Risk
According to the latest report, projections from global stroke specialists suggest that by the year 2050, 91 percent of stroke-related fatalities, totaling 8.8 million individuals, will be concentrated in low- and middle-income countries. This represents an increase from the current 86 percent. Concurrently, it is anticipated that stroke-related deaths in high-income nations will persist at approximately 900,000 over the next thirty years, exacerbating the existing gap in disparities.
“The biggest thing is that uncontrolled risk factors are becoming more prevalent,” said Eseosa Ighodaro, MD, PhD, a stroke neurologist, neuroscientist, and health disparities researcher at Emory University Hospital and Grady Memorial Hospital in Atlanta. “We’re becoming heavier as a world. We’re becoming more sedentary, and diabetes and high blood pressure are on the rise.”
Bruce Ovbiagele, MD, a professor of neurology and associate dean at the University of California in San Francisco, notes that the increasing prevalence of chronic diseases is a result of these lifestyle changes. Dr. Ovbiagele points out that hemorrhagic stroke, resulting from a ruptured blood vessel in the brain, is more prevalent in certain low- and middle-income countries than in wealthier nations. Data from the National Library of Medicine reveals a higher incidence of hemorrhagic stroke in low- and middle-income countries, particularly among Asian individuals.
“That’s the type of stroke that is more lethal,” said Ovbiagele, which may also contribute to the rising number of stroke deaths in the years to come.
However, there is another encouraging factor: In low- and middle-income countries, people are experiencing increased life expectancy, resulting in a higher number of older individuals who are reaching an age where they may be susceptible to strokes. Dr. Ovbiagele refers to this trend as the epidemiological transition, which involves shifts in fertility and mortality patterns, encompassing changes in life expectancy and the predominant causes of death.
However, countries with lower and middle incomes also face challenges in managing an increase in strokes due to limited resources and healthcare infrastructure.
“These countries don’t have the kind of medical infrastructure that we do in high-income countries,” said Ovbiagele, noting that the fact that stroke incidents are on the rise worldwide alone and this will also raise the number of those who die from it. “But the fact that more of these strokes are happening in these places where these resources aren’t there, this could lead to even more stroke deaths in those countries, and therefore globally, moving forward.”
The timely management of stroke is paramount, as both survival and rehabilitation outcomes are significantly compromised if intervention does not occur within a few hours of the onset. Swift access to medical facilities for the administration of clot-dissolving medications or surgical procedures is crucial in mitigating the adverse effects of a stroke. However, the availability of resources following acute treatment plays a pivotal role in enhancing the likelihood of recovery without lasting disabilities.
According to a recent report, projections indicate a substantial escalation in the direct costs and income loss associated with strokes, with an anticipated more than doubling of these figures to reach $2.31 trillion by the year 2050. The economic repercussions are expected to disproportionately impact Asian and African countries. This underscores the urgency of not only efficient acute stroke care but also the imperative need for accessible and comprehensive post-treatment resources to alleviate the economic burden and facilitate a better quality of life for stroke survivors.
“There is a shortage of specialty care and limited access to things like physical therapy, cognitive therapy, or neurologists,” Dr. Ighodaro said. “That plays a big role in poor stroke outcomes.”
Can the Problem be Solved?
It’s crucial to remember that the majority of strokes are preventable rather than inevitable, according to Ovbiagele.
“We know there is a tsunami coming, so right now is the best time to address it,” he stated.
Taking steps such as abstaining from smoking, engaging in regular exercise, adopting a diet low in processed foods and rich in vegetables, and effectively managing pre-existing conditions like type 2 diabetes and high blood pressure can empower individuals to diminish their risk of stroke.
However, to bring about substantial transformations, Ovbiagele emphasized the necessity for systemic changes at a broader level.
“We have known for 50 years that African Americans have a higher burden of stroke than white Americans. But we can only explain 50 percent of that disparity through higher incidence of risk factors like hypertension,” he then added.
Ighodaro also suggested that the increased incidence of strokes among Black Americans in the United States, as well as in low- and middle-income countries, is likely attributed to social determinants of health such as access to healthcare, availability of nutritious food, and geographic location.
“It’s not an easy fix,” Ighodaro said. “It’s going to take governments realizing this is a fix and allocating the finances needed to develop infrastructure in low- and middle-income countries and right here in the United States.”
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