| چکیده انگلیسی مقاله |
Background and Aim: Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.
Materials and Methods: We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.
Results: Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3–161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0–1374.7 per 100,000 in 2017), and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9–82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1–71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.
Conclusion: Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden, thus screening of people from low SES at higher stroke risk is crucial. |
| نویسندگان مقاله |
| Abolfazl Avan
Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| Hadi Digaleh
Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| Mario Di Napoli
Neurological Service, San Camillo de’ Lellis General Hospital, Rieti, Italy
| Saverio Stranges
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| Reza Behrouz
7 Stroke Program, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX
| Golnaz Shojaeianbabaei
Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| Amin Amiri
Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| Reza Tabrizi
Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| Naghmeh Mokhber
Department of Psychiatry & Behavioural Neurosciences, Western University, London, Ontario, Canada
| David J. Spence
Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| Mahmoud Reza Azarpazhooh
1Department of Clinical Neurological Science, Western University, London, Ontario, Canada
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