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Neuroepidemiology. 2015;45(3):177-89. doi: 10.1159/000441087. Epub 2015 Oct 28.

Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013.

Collaborators (160)

Thrift AG, Meretoja A, Stavreski B, Anderson CS, Pearse E, Donnan G, Hankey GJ, Mackay MT, Davis S, Ademi Z, Brainin M, Guliyev T, Hamadeh RR, Harewood H, Springer K, Leite Ida C, Fernandes JG, Cabral NL, Lotufo PA, Dokova K, Pourmalek F, deVeber G, Sposato LA, Lindsay MP, Riccio PM, Lavados PM, Li B, Yu C, Jiang G, Ma J, Zhou M, Liu M, Zhu S, Wang W, Liang X, Zhang Y, Alcalá-Cerra G, Christensen HK, Truelsen T, Abd-Allah F, Temesgen A, Sahle BW, Abera SF, Melaku YA, Nand D, Giroud M, Jonas JB, Endres M, Westerman R, Stroumpoulis K, Prabhakaran D, Pandian JD, Mehndiratta MM, Roy N, Jeemon P, Gupta R, Rajagopalan V, Kosen S, Warouw TS, Malekzadeh R, O'Donnell MJ, Tanne D, Bornstein NM, Ricci S, Caso V, Kokubo Y, Shinohara Y, Asad MM, Bwire VK, Jee SH, Khang YH, Yunjin K, Sahathevan R, Campos-Nonato I, Gankpé F, Myint CY, Geleijnse JM, Parmar P, Krishnamurthi RV, Barker-Collo S, Feigin VL, Akinyemi RO, Norheim O, Khalifa SE, Kravchenko M, Piradov M, Shalamov N, Vlassov VV, Varakin Y, Ngirabega Jde D, Nyemazi JP, Muhimpundu MA, Saeedi M, Bedi N, Venketasubramanian N, Kengne AP, Rojas-Rueda D, Catalá-López F, Dharmaratne SD, Norrving B, Havmoeller R, Atwine L, Banerjee A, Wolfe C, Bennett DA, Cundiff DK, O'Callaghan F, Shiue I, Critchley JA, Ezzati M, Soljak M, Connor MD, Rothwell PM, Chowdhury R, Al-Shahi Salman R, Whiteley W, Chen Z, Colomar M, Durrani AM, Dayama A, Moran AE, Misganaw A, Kissela BM, Amlie-Lefond C, Johnson CO, Huang C, Murray CJ, Sumeet C, Kim D, Cundiff DK, Tirschwell DL, Kazi DS, Qato D, Kabagambe EK, Ding E, Bukhman G, Kwan G, Mensah GA, Thurston GD, Nguyen G, Roth GA, Coresh J, Lefondulq K, Sheth KN, Corriere MA, Forouzanfar MH, Naghavi M, Mainoo N, Beauchamp NJ, Sacco RL, Gillum RF, Basu S, Schwartz SM, Chugh S, Fung T, Vos T, Byers TE, Sampson UK, Rocca WA, Lo W.

Author information

National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.



There is increasing recognition of stroke as an important contributor to childhood morbidity and mortality. Current estimates of global childhood stroke burden and its temporal trends are sparse. Accurate and up-to-date estimates of childhood stroke burden are important for planning research and the resulting evidence-based strategies for stroke prevention and management.


To estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013.


Stroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease 2013 methods. All available data on stroke-related incidence, prevalence, excess mortality and deaths were collected. Statistical models and country-level covariates were employed to produce comprehensive and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013.


In 2013, there were 97,792 (95% UI 90,564-106,016) prevalent cases of childhood IS and 67,621 (95% UI 62,899-72,214) prevalent cases of childhood HS, reflecting an increase of approximately 35% in the absolute numbers of prevalent childhood strokes since 1990. There were 33,069 (95% UI 28,627-38,998) deaths and 2,615,118 (95% UI 2,265,801-3,090,822) DALYs due to childhood stroke in 2013 globally, reflecting an approximately 200% decrease in the absolute numbers of death and DALYs in childhood stroke since 1990. Between 1990 and 2013, there were significant increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rates for childhood IS and HS decreased significantly in developed countries, a decline was seen only in HS, with no change in prevalence rates of IS, in developing countries. The childhood stroke DALY rates in 2013 were 13.3 (95% UI 10.6-17.1) for IS and 92.7 (95% UI 80.5-109.7) for HS per 100,000. While the prevalence of childhood IS compared to childhood HS was similar globally, the death rate and DALY rate of HS was 6- to 7-fold higher than that of IS. In 2013, the prevalence rate of both childhood IS and HS was significantly higher in developed countries than in developing countries. Conversely, both death and DALY rates for all stroke types were significantly lower in developed countries than in developing countries in 2013. Men showed a trend toward higher childhood stroke death rates (1.5 (1.3-1.8) per 100,000) than women (1.1 (0.9-1.5) per 100,000) and higher childhood stroke DALY rates (120.1 (100.8-143.4) per 100,000) than women (90.9 (74.6-122.4) per 100,000) globally in 2013.


Globally, between 1990 and 2013, there was a significant increase in the absolute number of prevalent childhood strokes, while absolute numbers and rates of both deaths and DALYs declined significantly. The gap in childhood stroke burden between developed and developing countries is closing; however, in 2013, childhood stroke burden in terms of absolute numbers of prevalent strokes, deaths and DALYs remained much higher in developing countries. There is an urgent need to address these disparities with both global and country-level initiatives targeting prevention as well as improved access to acute and chronic stroke care.

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