Stroke is a leading contributor to the global burden of disease, as measured in disability-adjusted life-years (DALYs).1 Age-standardized DALYs (per 100 000) for stroke are greater in countries with lower levels of Gross National Income (GNI) per capita (Figure). For example, the rate in Ethiopia (GNI/capita, $590) is more than 4-fold higher than the rate in the United States (GNI/capita, $54 960).1 In the United States and other high-income countries (ie, developed countries), there is considerable enthusiasm for expanding acute stroke services, such as telemedicine, to support emergency department physicians for thrombolysis and endovascular treatments using stent retrievers. In low- and middle-income countries (LMICs; ie, developing countries), these services are largely nonexistent or only available to the minority of individuals able to pay for treatment at private hospitals. In some LMICs, public (government-supported) hospitals offer thrombolysis but require a copayment for the medication that many patients are unable to afford. The substantial costs for acute stroke treatment, both diagnostic and therapeutic, combined with the lack of basic health insurance for most citizens in LMICs argue strongly for a more “upstream” approach focusing on primary prevention to combat the rising global burden of stroke.
Chin JH, Bhatt JM, Lloyd-Smith AJ. Hypertension—A Global Neurological Problem. JAMA Neurol. Published online February 06, 2017. doi:10.1001/jamaneurol.2016.4718