The evidence shows that age-standardised incidence rates for stroke are falling. This is welcome, but this trend is outweighed by an ageing population. Improved survival rates from stroke mean there will be more people living with stroke as a long-term condition.
Models estimating future stroke burden usually combine national demographic projections with estimated incidence and survival rates, sometimes covering a best case and worst case scenario. Based on these methods, a 36% increase in the number of stroke events was predicted for the European Union combined with Iceland, Norway, and Switzerland between 2000 (1.1 million) and 2025 (1.5 million). Only a few studies have calculated future stroke burden on a country-level, but they are all predicting a significant increase (Table 5).
Table 5: European studies estimating the future burden of stroke
|Netherlands||2000 – 2020||Incidence: +17%
Potential Years of Life Lost: +30%
|Finland||2000 – 2030||Number of strokes nationally assuming
• Stable incidence rates: +75%
• Incidence rates continue to decline: +5%
|Germany / Hesse||2005-2050||Number of strokes regionally assuming stable incidence rate: +68%|
|Ireland||2007 – 2021||Number of strokes nationally assuming stable incidence rate: +58%|
|Sweden||2001/2 – 2050||Number of stroke cases nationally assuming
• Stable incidence rates: +59%
• Rates decreasing 2% every 5 years: +33%
• Rates increasing 2% every 5 years: +91%
|Italy||1991-2016||Number of strokes nationally assuming stable incidence rate: +22%|
|UK||1983 – 2023||Number of strokes nationally assuming stable incidence rate: +30%|
For this report, we have calculated epidemiological projections for all EU countries for 2025 and 2035 using the most recent age and sex-specific GBD incidence, prevalence, death, and DALY-rates. These rates were applied to the demographic projections for each country (broken down by age and sex) obtained from Eurostat to obtain projected absolute numbers. Again, we want to emphasise that a significant level of uncertainty is attached to all country-level estimates. However, as percentage change over time in our model depends purely on changes in the demographic make-up, those percentage changes should be more reliable than absolute figures.
Using GBD incidence rates, between 2015 and 2035, there will be a 34% increase in total number of stroke events in the EU from 613,148 in 2015 to 819,771 in 2035.
This is consistent with the expectation that the ageing of the population will outweigh the drop in age-standardised incidence rates (figure 3). The largest percentage increase will be seen in Luxembourg (78%) and largest absolute increase in Poland (26,807) (Figure 3). Our projections for the percentage change in stroke events and DALYs lost 2015-2035 can be found for each country in the separate report named “Overview of stroke burden and care in each EU and SAFE member country, SAFE, 2017”
Figure 3: Estimated number of strokes in 2015 and 2035 in EU countries