Over the last three decades global stroke incidence and mortality rates have decreased. However, the absolute numbers of people affected by stroke, and those who die from or remain disabled by stroke have increased in all countries of the world. Beginning in 2016, stroke became the second leading cause of death and disability in the world (see Feigin et al. [2017] in Suggested Reading for Section VI). Since 2010 there has been an increase in global stroke mortality and disability-adjusted life-years (DALYs) rates (Fig. 32-1). Moreover, there are large geographical differences in stroke incidence, mortality, prevalence, and DALYs lost. The highest stroke incidence, mortality, prevalence, and DALYs rates are observed in Eastern European countries and some Asian countries (particularly in China), with the bulk of the burden (75% deaths and 81% DALYs) residing in low- to middle-income countries. Importantly, stroke is no longer a disease of the elderly: in 2016, globally almost 60% of people affected by stroke were under 70 years of age, and there was a large and ongoing increase in stroke incidence rates among those aged 15 to 49 years. In 2016, there were over 80 million stroke survivors in the world, over 14 million people experienced their first-ever stroke annually, and over 5.5 million people died from stroke annually. Globally, age-standardized stroke incidence, mortality, prevalence, and DALYs rates in men (231/100,000
uncertainty interval [UI] 215-248/100,000; 103/100,000 UI 67-77; 1,232/100,000 UI 1,143-1,334; and 2,046/100,000 UI 1,960-2,126, respectively) were significantly greater than that in women (179/100,000 UI 166-192; 73/100,000 UI 67-77; 1,136/100,000 UI 1,049-1,225; and 1,408/100,000 UI 1,320-1,489, respectively; see Institute for Health Metrics and Evaluation [2016] in Suggested Reading for Section VI; Figs. 32-2, 32-3, 32-4).