Stroke Facts in Developed Countries
- cause no 1 of disability
- cause no 2 of dementia
- cause no 3 of death
- major cause of epilepsy, falls and depression 7
A stroke is caused by either a sudden reduction in the blood supply to the brain or by a hemorrhage 10. Most strokes (85%) are ischaemic (caused by thrombosis or embolisms) and the rest (15%) are haemorrhagic (caused mainly by rupture of blood vessel or aneurysm). Eight to twelve per cent of ischaemic strokes and 37% to 38% of haemorrhagic strokes result in death within 30 days. Hemorrhagic strokes are less common but they are responsible for about 40 percent of all stroke deaths 11.
Stroke is the leading cause of disability among adults in the U.S. An estimated 6.8 million (2.8%) of people in the United States are living after having had a stroke, including 3.8 million women and 3 million men 16. Stroke is the second leading cause of disability in Europe after ischaemic heart disease (I HD) and is the sixth leading cause worldwide 12 13 14.Stroke is the second single most common cause of death in Europe: accounting for almost 1.1 million deaths each year 15.
Cost of stroke in the US:
2007 AHA ESTIMATES:
- Direct and indirect costs = $40 billion
- Mean lifetime cost = $140,048
- Inpatient hospital costs for an acute stroke event account for 70% of first-year post stroke costs.
- Estimates of total stroke cost between 2005-2050, in US dollars is projected to be $1.52 trillion for non-Hispanic whites, $313 billion for Hispanics, and $379 billion for Blacks
- Loss earnings is expected to be the highest cost contributor in eachrace/ethnic group 16.
The estimated cost of haemorrhagic stroke in Europe in 2010 was approximately € 8.3 billion 17.
According to the WHO, estimates the number of stroke events in EU countries, Iceland, Norway, and Switzerland is likely to increase from 1.1 million per year in 2000 to more than 1.5 million per year in 2025 solely because of the demographic changes 18.
The World Health Organization (WHO) predicts that disability-adjusted life years (DALYs) lost to stroke (a measure of the burden of disease) will rise from 38 million in 1990 to 61 million in 2020 19 20 21.
If these trends in stroke incidence, mortality, and DALYs continue, by 2030 there will be almost 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally 22 15. Between 2012 and 2030, total direct medical stroke-related costs are projected to triple, from $71.6 billion to $184.1 billion, with the majority of the projected increase in costs arising from those 65 to 79 years of age 23 16.
SDH can occur in about one third of people with a severe head injury 24.
Subdural haematomas occur not only in patients with severe head injury but also in patients with moderate head injuries, particularly those who are elderly or who are receiving anticoagulants. Subdural haematoma may also be spontaneous or caused by a procedure, such as a lumbar puncture. Rates of mortality and morbidity can be high, even with the best medical and neurosurgical care.
The incidence of chronic SDH is rising; SDH is projected to become the most common cranial neurosurgical condition among adults by the year 2030. Thus by 2030, chronic SDH drainage may be the most commonly performed neurosurgical procedure 25.
For UK, admissions for traumatic SDH increased 154% from 1993 to 2006 26, average costs increased 67% to $47,315 per admission 27 and national cost increased from $1.0 to $1.6 billion 28.
1 Torres A1, Plans G, Martino J, Godino O, Garcia I, Gracia B, Acebes JJ. Fibrinolytic therapy in spontaneous intraventricular haemorrhage: efficacy and safety of the treatment. Br J Neurosurg. 2008 Apr;22(2):269-74
3 Anderson C.O. Tsang and Gilberto K.K. Leung, External Ventricular Drain Infections The University of Hong Kong, Hong Kong
4 Hoefnagel, D., Dammers, R., Ter Laak-Poort, M. P., & Avezaat, C. J. (2008). Risk factors for infections related to external ventricular drainage. Acta neurochirurgica, 150(3), 209-214; discussion 214
5 Yukio Ikeda, Hiroyuki Uchino, and Ryoichi Miyashita, Neuroanesthesia and Cerebrospinal Protection Chapter 15 : Role and Management of Intracranial Pressure in Neuroanesthesia
7 Marc Fisher MD, Bo Norrving MD, PhD, “American Heart Association, 1st Global Conference on Healthy Lifestyles and Noncommunicable Diseases Control Moscow”, 28-29 April, 2011 “The International Agenda for Stroke
8 Stroke Statistics – World Health Report 2002, from the WHO
9 2004 WHO World Atlas on CVD/Stroke
10 American Health Association & American Stroke Association, Hemorrhagic Stroke (Bleeds), updated 22 June 2015.
11 National Stroke Association, “Understand Strokes”
12 Heart Disease and Stroke Statistics – 2015, A Report From the American Heart Association, (Circulation.2015).
13 Awareness of Stroke Warning Symptoms, Centers for Disease Control and Prevention, May 9, 2008/57 (18);481-485
14 World Stroke Campaign
15 World Heart Day: New European statistics released on heart disease and stroke. European Society of Cardiology, 28 Sep 2012
16 2011 American Heart Association, Inc. Circulation. 2011;123:e18-e209
17 Olesen J1, Gustavsson A, Svensson M, Wittchen HU, Jönsson B; CDBE2010 study group; European Brain Council. The economic cost of brain disorders in Europe. Eur J Neurol. 2012 Jan;19(1):155-62. doi: 10.1111/j.1468-1331.2011.03590.x.
18 Eduardo Sabaté and Sunil Wimalaratna. Priority Medicines for Europe and the World “A Public Health Approach to Innovation”. Background Paper 6.6 Ischaemic and Haemorrhagic Stroke Update on 2004 Background Paper. WHO 2012
19 The Atlas of heart disease and Stroke – Atlas Global burden of stroke – WHO 2004
20 Valery L Feigin, Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010, on behalf of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group Lancet. 2014 Jan 18; 383(9913): 245–254.
21 Heart Disease and Stroke Statistics—2015 Update
A Report From the American Heart Association, (Circulation. 2015)
24 David S. Liebeskind, MD; Robert E.O’Connor MD, MPH, Hemorrhagic Stroke, Updated: Jan 08, 2015
25 Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations
J Neurosurg, Volume 123 • November2015, 123:1209–1215, 2015
26 National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Crit Care Med. 2011 Jul;39(7):1619-25. Frontera JA, Egorova N, Moskowitz AJ
27 Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States. J Neurosurg. 2011 Nov;115(5):1013-8 . Kalanithi P, Schubert RD, Lad SP, Harris OA, Boakye M.
28 The epidemiology of surgically treated acute subdural and epidural hematomas Can J Surg. 2008 Oct;51(5):339-45. Tallon JM, Ackroyd-Stolarz S, Karim SA, et al;