Comprehensive Study Categorizes Economic Consequences of Stroke on the Global, Regional and Country Levels

Stroke is associated with one of the highest disease burdens worldwide. That burden is expected to increase as populations age and many low- and middle-income countries transition from having infectious to noncommunicable diseases as their primary drivers of disease burden.

Researchers at Brigham and Women’s Hospital recently completed the first study that assessed the macroeconomic consequences of stroke and its subtypes globally in a standardized way.

Jakob V. E. Gerstl, MBBS, a research fellow in the Department of Neurosurgery, Sarah E. Blitz, a student at Harvard Medical School, Joshua D. Bernstock, MD, PhD, MPH, a clinical fellow in the Department of Neurosurgery, and colleagues also present regional and country-by-country estimates of economic consequences of stroke in Stroke.


The Global Burden of Disease (GBD) Study tracks regional and country-wide stroke incidence, mortality, and disease burden in disability-adjusted life-years (DALYs). The researchers obtained DALY data from the GBD Study database (age-specific rates per year per 100,000 people) for 173 countries in 2019.

They estimated economic losses using the value of lost welfare (VLW) approach, which combines DALYs and the concept of value of statistical life (VSL). The latter represents the maximum dollar value an individual will pay to prevent mortality. The U.S. government’s assessment of VSL in the U.S. was adjusted for each country’s gross domestic product (GDP) to yield the VSL for that country.

The GBD Study categorizes countries in the following super-regions:

  • High-income (n=30)
  • Central Europe, Eastern Europe, and Central Asia
  • Latin America and the Caribbean
  • North Africa and the Middle East
  • South Asia
  • Southeast Asia, East Asia, and Oceania
  • Sub-Saharan Africa


Globally in 2019, VLW due to stroke was:

  • Overall—$2,059.67 billion (1.66% of global GDP)
  • Ischemic stroke—$964.51 billion (0.78%)
  • Intracerebral hemorrhage—$882.81 billion (0.71%)
  • Subarachnoid hemorrhage—$212.36 billion (0.17%)

These figures are in 2017 international dollars, adjusted for purchasing power parity. Other key results were:

  • The super-regions with the highest overall stroke VLW/GDP were Central Europe, Eastern Europe and Central Asia, Southeast Asia, East Asia, and Oceania
  • High-income countries had a lower VLW/GDP than the global average for overall stroke and for all subtypes
  • The economic consequences of stroke subtypes differed substantially by super-region

Increased Resource Allocation Needed

A growing body of literature, now including these findings, demonstrates a disproportionate stroke burden in low- and middle-income countries. These regions lag in every aspect of stroke care: prevention, surveillance, diagnosis/acute care, and rehabilitation.

Increased spending on stroke is especially needed in those countries and should include population-wide interventions that target stroke risk factors.

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