ImportanceStroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies.ObjectiveTo present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location.Design, Setting, and ParticipantsAn in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020.ExposuresIn this study, no particular exposure was specifically targeted.Main Outcomes and MeasuresThe primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals.ResultsIn 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota).Conclusions and RelevanceIn this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.

中文翻译：

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1990 年至 2019 年美国缺血性和出血性中风的负担

重要中风是美国死亡和残疾的主要原因。需要准确和更新的中风负担测量方法来指导公共卫生政策。目的提出 2019 年美国缺血性和出血性中风的负担估计，并按年龄、性别和地理位置描述 1990 年至 2019 年的趋势。设计、设置和参与者对 2019 年全球疾病负担研究进行了深入的横断面分析。设定时间为美国 1990 年至 2019 年。该研究涵盖了各种类型中风的估计，包括所有中风、缺血性中风、脑出血（ICH）和蛛网膜下腔出血（SAH）。2019 年全球疾病负担结果于 2020 年 10 月 20 日发布。暴露在这项研究中，没有专门针对特定的暴露。主要结果和措施这项分析的主要重点集中在总体和年龄标准化估计、中风发病率、患病率、死亡率和每 10 万人的 DALY。 结果 2019 年，美国记录了 709 万中风患病率（407 万女性 [57.4%]；302 万男性 [42.6%]），其中 587 万是缺血性中风（82.7%）。患病率还包括 66 万例 ICH 和 85 万例 SAH。尽管从 1990 年到 2019 年，卒中病例、死亡率和伤残调整生命年 (DALY) 的绝对数量激增，但年龄标准化比率要么下降，要么保持稳定。值得注意的是，与缺血性中风相比，出血性中风显着增加，尤其是死亡率（缺血性中风的发病率增加了 13% [95% 不确定区间 (UI)，14.2%-11.9%]；ICH 的发生率增加了 39.8% [ 95% UI，38.9%-39.7%]；SAH 发生率增加 50.9% [95% UI，49.2%-52.6%]）。近十年来，中风死亡率的下降趋于稳定。卒中负担趋势存在明显的异质性，沿海地区老年人（50-74 岁）的发病率有所下降（佛蒙特州下降达 3.9%），而较年轻的人群（15-49 岁）则出现上升趋势。年）在美国南部和中西部（明尼苏达州增加高达 8.4%）。结论和相关性在这项横断面研究中，过去 30 年年龄标准化中风发生率的下降表明在管理中风相关结果方面取得了进展。然而，中风绝对负担的增加，加上出血性中风的显着增加，表明美国面临着不断变化的重大公共卫生挑战。此外，不同年龄组和地理位置的中风负担趋势存在显着差异，这凸显了针对特定地区和人口特征的干预措施和政策的必要性，以有效减轻该国多方面且不断升级的中风负担。