Availability of national surveillance systems for risk factors of stroke, Advanced stroke centres offer all the services provided at essential stroke centres in addition to thrombectomy or referral for thrombectomy, and essential stroke centers offer multidisciplinary care and thrombolytic therapy in addition to services offered by minimal stroke service centres.Credit: Lancet Neurology Commission 2023
The burden of disability stemming from stroke is increasing at an alarming rate, particularly in low- and middle-income countries with the incidence among young and middle-aged individuals on the rise globally. This is raising concerns about achieving Sustainable Development Goal 3.4, which aims to reduce the burden of stroke and other non-communicable diseases by a third by 2030, a new report published in The Lancet Neurology has shown.
The report from the World Stroke Organization and Lancet Neurology Commission Stroke Collaboration Group shed light on the pressing global challenge posed by the disease forecasting a widening health and economic impacts between 2020 and 2050, between low- and middle-income countries (LMICs) and high-income countries (HICs).Based on a review of evidence-based guidelines, recent surveys and in-depth interviews with stroke experts, the authors made evidence-based recommendations to reduce the global burden, including measures to improve surveillance, prevention, acute care and rehabilitation.
According to the study, the number of people who die from stroke globally is estimated to increase by 50% by 2050 to 9.7 million deaths per year, with annual costs as high as US$2.3 trillion. Furthermore, deaths from stroke increased from 86% in LMICs and 14% in HICs in 2020 to a projection of 91% in LMICs and 9% in HICs by 2050. The forecast indicates that the bulk of the economic impacts (including direct costs and loss of income) from stroke will be felt in Africa and Asia.
The authors’ project that achieving the SDG goal 3.4 would require US$140 billion in new spending between 2023 and 2030, however, the financial benefits would outweigh the costs by a ratio of nineteen-to-one.
Valery Feigin, of Auckland University of Technology, New Zealand, one of the lead authors of the Commission, noted that although precisely forecasting the health and economic impacts of stroke decades into the future is inherently challenging given the levels of uncertainty involved. Nevertheless, "these estimates are indicative of the ever-increasing burden we will see in the years ahead unless urgent, effective action is taken,” he added.
Pragmatic Solutions
To identify key barriers and facilitators to high-quality stroke surveillance, prevention, acute care and rehabilitation, the authors conducted a qualitative analysis of in-depth interviews of 12 stroke experts from six HICs and six LMICs.
Low awareness of stroke and its risk factors (which include high blood pressure, diabetes, high cholesterol, obesity, unhealthy diet, sedentary lifestyle, and smoking), and limited surveillance data on stroke risk factors, its management, and outcomes were among the major barriers identified by the report.
The authors made 12 evidence-based recommendations, including:
● Establishing of low-cost surveillance systems, as well as incorporating regular national risk factor surveillance in national censuses to provide accurate epidemiological stroke data.
● Raising public awareness and action to encourage healthy lifestyles and prevent stroke through population-wide use of telemedicine and digital technologies, such as training and awareness-raising videos and apps.
● Establishing regional networks for effective planning of acute stroke care services, training of community healthcare workers, provision of appropriate equipment as well as freely accessible and affordable medicines supported by universal health coverage.
● Investing in research to generate innovative low-cost interventions to improve demand for rehabilitation services, and in advocacy to mobilise resources and financial solutions for multidisciplinary rehabilitation, especially in low-income and middle-income countries.
● Establishing local, national and regional networks involving all relevant stakeholders to co-create, co-implement and monitor stroke surveillance, prevention, acute care and rehabilitation.
Mayowa Owolabi, lead Commission co-chair and Professor of Neurology at the University of Ibadan, Nigeria says future basic science and translational research should focus on genomics, transomics, and precision medicine to develop prophylactic interventions for stroke patients, especially include participants from underserved populations in LMICs and of different ethnicities, as this will ensure the interventions are globally applicable.
