Supplementary Material for: Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017

<b><i>Background:</i></b> Stroke is a leading cause of death and disability in globally and particularly in low- and middle-income countries, and this burden is increasing. The burden of stroke pathological subtypes varies in terms of incidence, disability and mortality. Previous Global Burden of Diseases, Injuries, and Risk Factors Studies (GBD) reports did not provide separate global burden and trends estimates for haemorrhagic stroke by primary intracerebral haemorrhage (PICH) and subarachnoid haemorrhage (SAH). <b><i>Aim:</i></b> To summarise the GBD 2017 findings for the burden and 27-year trends for ischaemic stroke (IS), intracerebral haemorrhage and SAH by age, sex and country income level in 21 world regions and associated risk factors. <b><i>Methods:</i></b> Data on stroke incidence, prevalence, mortality and disability-adjusted life-years (DALY) lost and the burden of IS, PICH and SAH were derived from all available datasets from the GBD 2017 studies. Data were analysed in terms of absolute numbers and age-standardised rates per 100,000 (95% uncertainty interval [UI]), with estimates stratified by age, sex and economic development level by the World Bank classification. We also analysed changes in the patterns of incidence, mortality and DALYs estimates between 1990 and 2017. <b><i>Results:</i></b> In 2017, there were 11.9 million incident (95% UI 11.1–12.8), 104.2 million prevalent (98.6–110.2), 6.2 million fatal (6.0–6.3) cases of stroke and 132.1 million stroke-related DALYs (126.5–137.4). Although stroke incidence, prevalence, mortality and DALY rates declined from 1990 to 2017, the absolute number of people who developed new stroke, died, survived or remained disabled from stroke has almost doubled. The bulk of stroke burden (80% all incident strokes, 77% all stroke survivors, 87% of all deaths from stroke and 89 of all stroke-related DALYs) in 2017 was in low- to middle-income countries. Globally in 2017, IS constituted 65%, PICH –26% and SAH –9% of all incident strokes. <b><i>Discussion:</i></b> The latest GBD estimates of stroke burden in 195 countries supersede previous GBD stroke burden findings and provide most accurate data for stroke care planning and resource allocation globally, regionally and for 195 countries. Stroke remains the second leading cause of deaths and disability worldwide. The increased stroke burden continues to exacerbate a huge pressure on people affected by stroke, their families and societies. It is imperative to develop and implement more effective primary prevention strategies to reduce stroke burden and its impact.

<b><i>背景：</i></b> 脑卒中（Stroke）是全球范围内致死、致残的主要病因之一，在低收入和中等收入国家尤为突出，且其疾病负担正逐年攀升。脑卒中不同病理亚型的疾病负担在发病率、致残率及死亡率层面存在显著差异。既往《全球疾病、损伤和危险因素负担研究》（Global Burden of Diseases, Injuries, and Risk Factors Studies, GBD）的相关报告并未针对出血性脑卒中的两个亚型——原发性脑内出血（primary intracerebral haemorrhage, PICH）和蛛网膜下腔出血（subarachnoid haemorrhage, SAH）——分别给出全球疾病负担及流行趋势的估算数据。
<b><i>研究目的：</i></b> 本研究旨在总结2017年全球疾病负担研究（GBD 2017）的成果，按年龄、性别、国家收入层级，分析全球21个区域内缺血性脑卒中（ischaemic stroke, IS）、脑内出血及蛛网膜下腔出血的疾病负担与27年流行趋势，并探讨其相关危险因素。
<b><i>研究方法：</i></b> 本研究所需的脑卒中发病率、患病率、死亡率、伤残调整寿命年（disability-adjusted life-years, DALY）损失数据，以及缺血性脑卒中、原发性脑内出血、蛛网膜下腔出血的疾病负担数据，均来源于2017年全球疾病负担研究的全部可用数据集。研究采用绝对数及每10万人年龄标化率（95%不确定区间，UI）进行数据分析，并按年龄、性别及世界银行分级的经济发展水平对估算结果进行分层。同时，本研究还分析了1990年至2017年间脑卒中发病率、死亡率及伤残调整寿命年估算值的变化模式。
<b><i>研究结果：</i></b> 2017年，全球共有脑卒中新发患者1190万例（95%不确定区间：1110万~1280万）、现患患者1.042亿例（9860万~1.102亿）、死亡患者620万例（600万~630万），脑卒中相关伤残调整寿命年达1.321亿（1.265亿~1.374亿）。尽管1990年至2017年间，脑卒中的发病率、患病率、死亡率及伤残调整寿命年率均有所下降，但新发脑卒中、因脑卒中死亡、存活或遗留脑卒中相关残疾的患者绝对数几乎翻倍。2017年，全球绝大多数脑卒中疾病负担（占全部新发脑卒中的80%、脑卒中存活患者的77%、脑卒中死亡病例的87%以及脑卒中相关伤残调整寿命年的89%）集中于低收入及中等收入国家。2017年全球范围内，缺血性脑卒中、原发性脑内出血、蛛网膜下腔出血分别占全部新发脑卒中病例的65%、26%及9%。
<b><i>讨论：</i></b> 本次发布的195个国家脑卒中疾病负担的最新GBD估算结果，替代了既往GBD关于脑卒中疾病负担的研究结论，可为全球、各区域及195个国家的脑卒中医疗规划与资源配置提供最为精准的数据支撑。脑卒中仍是全球范围内第二大致死及致残的主要病因。不断加重的脑卒中疾病负担，持续给脑卒中患者、其家属及整个社会带来沉重压力。因此，制定并推行更为有效的一级预防策略，以减轻脑卒中疾病负担及其不良影响，已成为当务之急。