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  • Review Article
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Addressing disparities in the global epidemiology of stroke

Nature Reviews Neurology volume 20, pages 207–221 (2024)Cite this article

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Abstract

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.

Key points

  • Stroke is a leading cause of death and disability worldwide, and its incidence is rising rapidly in low-income and middle-income countries (LMICs), where health systems cannot cope with the growing burden.

  • Exposure to risk factors for stroke has increased substantially in LMICs as the global population has aged, living standards have increased, and childhood and infectious disease mortality has fallen.

  • Critical resource gaps across all phases of stroke care delivery, including prehospital care, inpatient services and rehabilitation, increase stroke-related morbidity and mortality in LMICs.

  • In high-income countries (HICs), stark disparities remain in stroke epidemiology and outcomes along racial, ethnic and geographical lines.

  • Curbing the disparate burden of stroke in LMICs and HICs will require organized commitments to strengthen systems for data gathering and care delivery by stakeholders at local, national and global levels.

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Fig. 1: Trends in stroke epidemiology in low-income and middle-income countries and high-income countries.
Fig. 2: Stroke-related mortality and disability-adjusted life years attributable to leading risk factors for stroke.
Fig. 3: The impacts of limited resources in low-income and middle-income countries on stroke care.

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Authors and Affiliations

  1. Department of Neurology, Yale School of Medicine, New Haven, CT, USA

    Morgan L. Prust & Rachel Forman

  2. Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA

    Bruce Ovbiagele

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Related links

Angels Initiative Academy: www.angels-initiative.com/angels-academy

Online WSO quality care assessment tool: www.world-stroke.org/what-we-do/education-and-research/improving-access-to-quality-stroke-care/global-stroke-services-guideline-action-plan/online-wso-quality-care-assessment-tool

Registry of Stroke Care Quality (RES-Q): eso-stroke.org/projects/eso-east/registry-of-stroke-care-quality-res-q/

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Prust, M.L., Forman, R. & Ovbiagele, B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 20, 207–221 (2024). https://doi.org/10.1038/s41582-023-00921-z

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