1.7 What do we predict about the future burden of stroke in Europe?

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)[76]. 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

 

Country

 

Projection period

 

Estimate

Netherlands[62] 2000 – 2020 Incidence: +17%

Prevalence: +16%

Potential Years of Life Lost: +30%

Finland[77] 2000 – 2030 Number of strokes nationally assuming

•  Stable incidence rates: +75%

•  Incidence rates continue to decline: +5%

Germany / Hesse[78] 2005-2050 Number of strokes regionally assuming stable incidence rate: +68%
Ireland[79] 2007 – 2021 Number of strokes nationally assuming stable incidence rate: +58%
Sweden[23] 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[80] 1991-2016 Number of strokes nationally assuming stable incidence rate: +22%
UK[81] 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

The number of stroke survivors in the EU will rise from 3,718,785 in 2015 to 4,631,050 in 2035, an increase of almost one million or 25%.

The largest increase will be in Luxembourg (72%) and the largest absolute number increase in the UK (193,861).

 

There will be a 45% increase in the number of stroke deaths from 532,321 in 2015 to 770,038 in 2035.

This ranges from a 10% increase in Lithuania to 101% increase in Malta, with Germany having the largest absolute increase of 29,243.

 

 

 

Overall there will be a 32% increase in DALYs lost from 2015 to 2035 (609,721 to 861,878).

The largest percentage increase is expected in Malta (63%) with almost no change in Lithuania  (1%).  The  UK  will  have  the  largest absolute increase of DALYs from 609,721 in 2015 to 861,878 in 2035.