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    • br Methods br Results Characteristics of

    2019-05-22


    Methods
    Results Characteristics of studies included in the analysis are described in the accompanying Lancet paper. We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries) in this cathepsin inhibitor analysis. Worldwide in 2010, an estimated 11 569 538 events of incident ischaemic stroke took place (63% in low-income and middle-income countries), and 5 324 997 events of incident haemorrhagic stroke (80% in low-income and middle-income countries); furthermore, 2 835 419 individuals died from ischaemic stroke (57% in low-income and middle-income countries) and 3 038 763 from haemorrhagic stroke (84% in low-income and middle-income countries; appendix). In 2010, 39 389 408 DALYs were lost because of ischaemic stroke (64% in low-income and middle-income countries) and 62 842 896 because of haemorrhagic stroke (86% in low-income and middle-income countries; appendix). In 2010, age-standardised incidence per 100 000 person-years of ischaemic stroke ranged from 51·88 in Qatar to 433·97 in Lithuania (table 1); incidence of haemorrhagic stroke ranged from 14·55 in Qatar to 159·81 in China; (table 2). Age-standardised mortality rates per 100 000 person-years for ischaemic stroke ranged from 9·17 in Qatar to 137·70 in Russia (table 1); the rate of haemorrhagic stroke ranged from 9·64 in the USA to 210·56 in Mongolia (table 2). DALYs lost per 100 000 people because of ischaemic stroke ranged from 163·89 in Israel to 2032·11 in Afghanistan (table 1); for haemorrhagic stroke the number of DALYs lost ranged from 178·20 in Switzerland to 4118·90 in Mongolia (table 2). In the past two decades in high-income countries, incidence of ischaemic stroke significantly reduced by 13% (95% CI 6–18), mortality by 37% (19–39), DALYs by 34% (16–36), and mortality-to-incidence ratios by 21% (10–27; table 3). Reductions shown for haemorrhagic stroke were 19% (1–15%) for incidence, 38% (32–43%) for mortality, 39% (32–44%) for DALYs, and 27% (19–35%) for mortality-to-incidence ratio (table 3). Reductions in incidence in both stroke groups were significant for the younger age group (<75 years, from 110·80/100 000 [95% CI 103·05–118·54] to 100·47/100 000 [94·03–107·16], p=0·021, for incidence of ischaemic stroke, and from 41·92/100 000 [38·89–45·15] to 38·46/100 000 [35·68–41·16], p=0·038, for incidence of haemorrhagic stroke). Worldwide, in the younger age group, the incidence of ischaemic stroke did not change, but we noted a significant increase in the incidence of haemorrhagic stroke, from 54·07 (48·56–60·22) to 64·07 (56·45–73·33; p=0·028). In the older age group (≥75 years) we noted no significant change in the incidence of ischaemic stroke (from 2614·89/100 000 [2426·49–2809·55] to 2472·93/100 000 [2279·15–2687·39], p=0·176), whereas a significant reduction was shown in the incidence of haemorrhagic stroke (from 558·61/100 000 [503·36–624·07] to 640·06/100 000 [569·10–724·72], p=0·046). We noted a significant increase of 22% (95% CI 5–30) in the incidence of haemorrhagic stroke in low-income and middle-income countries in the past two decades, with a 19% (5–30) significant increase in people younger than 75 years. A non-significant increase of 6% (18%, −7 to 32) was shown in the incidence of ischaemic stroke; additionally, mortality rates were reduced by 14% (–2% to 32), DALYs lost by 16% (1–35%), and mortality-to-incidence ratio by 16% (–5% to 37); however, these differences were not significant. Similarly for haemorrhagic stroke, mortality rates were reduced by 23% (–3% to 36%), DALYs lost by 25% (7–38%), and mortality-to-incidence ratio by 36% (16–49%), likewise not significantly. In the past two decades, the incidence of both ischaemic and haemorrhagic stroke in low-income and middle-income countries increased significantly in people aged 20–64 years (table 3). Worldwide, the mean age of people with incident and fatal stroke has increased in the past two decades, with the largest increase noted in high-income countries (table 4). In 2010, the mean age of patients with incident and fatal ischaemic and haemorrhagic stroke was 3–5 years greater in high-income than in low-income to middle-income countries (table 4).