Human and economic burden of stroke.

Stroke is a costly disease from human, family and societal perspectives. Starting from human costs, stroke is a leading cause of death and disability. Annually, about 16 million first-ever strokes occur in the world, causing a total of 5.7 million deaths [1]. As a consequence, stroke ranks as the second cause of death in the world population after ischaemic heart disease (the third only if neoplastic diseases are considered as a group). In the United States, figures indicate a total of 5,800,000 prevalent stroke cases, with 780,000 first-ever or recurrent strokes expected each year [2]. In the elderly population of the 15-country Europe, estimates showed 2,700,000 prevalent cases, and 536,000 incident cases each year [3, 4]. Total number of stroke deaths in 48 European countries is currently estimated at 1,239,000 per year (508,000 per year in the 27 European Union members) [5]. Stroke is a global epidemic, and by no way a problem limited to western or high-income countries. About 85% of all stroke deaths are registered in low-and middle-income countries, which also account for 87% of total losses due to stroke in terms of disability-adjusted life years (DALYs), calculated, worldwide, in 72 millions per year [6]. Present and future figures of stroke are strictly related to the demographic transition, occurring in both developed and developing countries. The world population aged 60 and over was 488 millions in 1990, and was projected to about 1,363 millions in 2030, with a percentage increase of 180%. In 1990, developing countries contained the 58% of the world elderly, while in 2030 about two-thirds of the total elderly population will be dwelling in these countries [7]. Given that age is one of most substantiated risk factor for stroke, the ageing of the world population implies a growing number of persons at risk. Among EU members, for instance, Italy is the country with the highest percentage of people over the age of 65 years (19.9%). About 153,000 new stroke cases are expected each year in the Italian elderly population. Assuming stable incidence rates, a total of 195,000 new cases per year are expected in 2020, simply due to the ageing population [8]. While stroke will firmly remain the second cause of death in the world by 2030, its ranking as a major cause of DALY loss will increase during the same period [9]. About half of stroke survivors are left with some degree of physical …