(2024) Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. Neurology. pp. 973-1003. ISSN 1474-4465 (Electronic) 1474-4422 (Linking)
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Official URL: https://www.ncbi.nlm.nih.gov/pubmed/39304265
Abstract
BACKGROUND: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990-2021. METHODS: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index SDI quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2.5th and 97.5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FINDINGS: In 2021, stroke was the third most common GBD level 3 cause of death (7.3 million 95% UI 6.6-7.8 deaths; 10.7% 9.8-11.3 of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160.5 million 147.8-171.6 DALYs; 5.6% 5.0-6.1 of all DALYs). In 2021, there were 93.8 million (89.0-99.3) prevalent and 11.9 million (10.7-13.2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65.3% (62.4-67.7), intracerebral haemorrhage constituted 28.8% (28.3-28.8), and subarachnoid haemorrhage constituted 5.8% (5.7-6.0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88.2% 53.4-117.7), high ambient temperature (72.4% 51.1 to 179.5), high fasting plasma glucose (32.1% 26.7-38.1), diet high in sugar-sweetened beverages (23.4% 12.7-35.7), low physical activity (11.3% 1.8-34.9), high systolic blood pressure (6.7% 2.5-11.6), lead exposure (6.5% 4.5-11.2), and diet low in omega-6 polyunsaturated fatty acids (5.3% 0.5-10.5). INTERPRETATION: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. FUNDING: Bill & Melinda Gates Foundation.
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| Keywords: | Humans *Global Burden of Disease Risk Factors *Stroke/epidemiology *Global Health Disability-Adjusted Life Years Incidence Prevalence Quality-Adjusted Life Years Male Female the Middle East and North Africa Stroke Organization, unpaid, as Vice President, outside the submitted work. S Afzal reports support for the present manuscript from King Edward Medical University through the provision of study material, research articles, valid data sources and authentic real time information for this manuscript payment or honoraria for educational events and webinars with King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, University of Massachusetts, KEMCAANA, and KEMCAUK participation on a Data Safety Monitoring Board or Advisory Board with the National Bioethics Committee Pakistan, the King Edward Medical University Ethical Review Board, the Ethical Review Board of Fatima Jinnah Medical University and Sir Ganga Ram Hospital, and being a member of the Technical Working Group on Infectious Diseases other financial and non-financial interests in King Edward Medical University, Annals of King Edward Medical University, Quality Enhancement Cell King Edward Medical University, Faculty of Public Health United Kingdom, Scientific Session, KEMCA-UK, International Scientific Conference, KEMCAANA, Research and Publications Higher Education Commission Pakistan, Research and Journals Committee Pakistan, Medical and Dental Council Pakistan, National Bioethics Committee Pakistan, Corona Experts Advisory Group, Technical Working Group on Infectious Diseases, Dengue Experts Advisory Group, Punjab Residency Program Research Committee, all outside the submitted work. R Akinyemi reports grants U19AG074865, U19 AG076581and R01AG072547 from the US National Institutes of Health/National Institute of Aging, GBHI ALZ UK-21- 24204 from the Alzheimer's Association and the Global Brain Health Institute, UK Royal Society/African Academy of Sciences FLAIR Grants FLR/R1/191813 and FCG/R1/201034, and GCRF Networking Grant from the UK Academy of Medical Sciences, all outside the submitted work. A Al-Ibraheem reports grants or contracts and support for attending meetings and/or travel from King Hussein Cancer Center, International Atomic Energy Agency consulting fees from University of Jordan leadership or fiduciary role, paid or unpaid, with Arab Society of Nuclear Medicine, and Asia Oceania Federation of Nuclear medicine and biology all outside the submitted work. R Ancuceanu reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Laropharm, and Reckitt, outside the submitted work. J Arnlov reports payment or honoraria for lectures from AstraZeneca and Novartis participation on an Advisory Board with AstraZeneca and Astella all outside the submitted work. M Ausloos reports grants or contracts from the project "A better understanding of socio-economic systems using quantitative methods from Physics" funded by European Union - NextgenerationEU and Romanian Government, under National Recovery and Resilience Plan for Romania, contract no.760034/ 23.05.2023, cod PNRR-C9-I8-CF 255/ 29.11.2022, through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, Investment I8, outside the submitted work. O C Baltatu reports grants or contracts from National Council for Scientific and Technological Development (CNPq, 304224/2022-7) and the Anima Institute through an AI research professor fellowship leadership or fiduciary role, paid or unpaid, with Health and Biotechnology Advisory Board at Technology Park Sao Jose dos Campos - Center for Innovation in Health Technologies (CITS), outside the submitted work. T W Barnighausen reports grants or contracts from National Institutes of Health, Alexander von Humboldt Foundation, German National Research Foundation (DFG), European Union, German Ministry of Education and Research, German Ministry of the Environment, Wellcome, and KfW payment or honoraria for serving as Editor-in-Chief of PLOS Medicine participation on a Data Safety Monitoring Board or Advisory Board, unpaid, with NIH-funded research projects in Africa on Climate Change and Health stocks in CHEERS, an SME focusing on approaches to measure climate change and health-related variables in population cohorts all outside the submitted work. S Bhaskar reports grants or contracts from Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) through Grant-in-Aid for Scientific Research (KAKENHI), and from JSPS and the Australian Academy of Science through the JSPS International Fellowship leadership or fiduciary role, paid or unpaid, with National Cerebral and Cardiovascular Center, Suita, Osaka, Japan, NSW Brain Clot Bank, Sydney, Australia, Rotary District 9675, Sydney, NSW, Australia, Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany, PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Aging, Frontiers in Public Health & BMC Medical Research Methodology, College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada, Cardiff University Biobank, Cardiff, UK, Cariplo Foundation, Milan, Italy, Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium all outside the submitted work. B Bikbov reports grants or contracts with European Commission, Politecnico di Milano, and University of Rome support for attending meetings and/or travel from European Renal Association leadership or fiduciary role, unpaid, with Advocacy Group, International Society of Nephrology and Western Europe Regional Board, International Society of Nephrology other non-financial in Scientific-Tools.org all outside the submitted work. A Biswas reports consulting fees from Lupin Pharmaceuticals India, Intas Pharmaceuticals India, Alkem Laboratories India, and Eisai Pharmaceuticals India, all outside the submitted work. E J Boyko reports Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Korean Diabetes Association, Diabetes Association of the R.O.C. (Taiwan), American Diabetes Association, and the International Society for the Diabetic Foot support for attending meetings and/or travel from Korean Diabetes Association, Diabetes Association of the R.O.C. (Taiwan), and International Society for the Diabetic Foot all outside the submitted work. A L Catapano reports grants or contracts from Amryt Pharma, Menarini, and Ultragenyx payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amarin, Amgen, Amryt Pharma, AstraZeneca, Daiichi Sankyo Esperion Ionis Pharmaceutical Medscaper, Menarini, Merck, Novartis, NovoNordisk, Peervoice Pfizer Recordati Regeneron, Sandoz, Sanofi The Corpus, Ultragenyx, and Viatris all outside the submitted work. S Das reports a leadership or fiduciary role, unpaid, with association of Diagnostic & Laboratory Medicine India Chapter and Women in Global Health India, outside the submitted work. A Demetriades reports Leadership or fiduciary role, paid or unpaid as the Immediate Past President, European Association of Neurosurgical Societies (EANS) and Vice-President, Global Neuro Foundation, outside the submitted work. A Faro reports support for the present manuscript from National Council for Scientific and Technological Development (CNPq) through a scholarship. M Foschi reports consulting fees from Novartis and Roche support for attending meetings and/or travel from Roche, Novartis, Biogen, Bristol-Meyer, Merck, and Sanofi leadership or fiduciary role with MSBase Foundation as a member of the scientific leadership group all outside the submitted work. R Franklin reports support for attending meetings and/or travel from ACTM - Tropical Medicine and Travel Medicine Conference 2022, 2023 and ISTM - Travel Medicine Conference, Basel 2023 leadership or fiduciary role, paid or unpaid, as Director of Kidsafe, Director of Auschem, Governance Committee of ISASH, Director of Farmsafe, SIG Convenor of PHAA Injury Prevention, and Vice President of ACTM all outside the submitted work. A Guha reports grants or contracts from American Heart Association and Department of Defense consulting fees from Pfizer and Novartis leadership or fiduciary role, paid or unpaid, with ZERO Prostate Cancer - health equity task force all outside the submitted work. G J Hankey reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from American Heart Association (for serving as Associate Editor of Circulation) Janssen (Johnson & Johnson) (for serving as Co-chair of Executive Committee, Librexia Stroke Trial, and lectures at sponsored scientific symposia), outside the submitted work. N E Ismail reports leadership or fiduciary role, unpaid, with Malaysian Academy of Pharmacy, Malaysia, and Malaysian Pharmacists Society Education Chapter, Malaysia, all outside the submitted work. T Joo reports support for the present manuscript from National Research, Development and Innovation Office in Hungary (RRF-2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security) for funding of participation in the research project. J J Jozwiak reports Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, ADAMED, and Amgen outside the submitted work. K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. B Lacey reports support for the present manuscript from UK Biobank, funded largely by the UK Medical Research Council and Wellcome. P M Lavados reports grants from Boehringer Ingelheim consulting fees from Boehringer Ingelheim for LATAM Stroke Projects Mentorship payment or honoraria for lectures from Boehringer Ingelheim, Ferrer, Pfizer, and Novartis support for attending Southamerican Angels meetings from Boehringer Ingelheim participation on a Data Safety Monitoring Board or Advisory Board with Janssen, BMS, and Pfizer leadership or fiduciary role, paid or unpaid, with Chilean Stroke Association (ACEVE) and Iberoamerican Stroke Society (SIECV-IASO) all outside the submitted work. M Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 112-2410-H-003-031 leadership or fiduciary role, paid or unpaid, as Technical Editor, Journal of the American Heart Association all outside the submitted work. D Lindholm reports previous stock options and other financial or non-financial interests in AstraZeneca as a former employee, outside the submitted work. W Lo report stock or stock options in Abbott Lab, Amgen, Becton Dickson, Bristol Myers Squibb, Cardinal Health, GE Healthcare, Illumina, McKesson, Merck, Moderna, Pfizer, and Walgreens Boots, outside the submitted work. S Lorkowski reports grants or contracts from dsm-firmenich (formerly DSM Nutritional Products) as payments to their institution consulting fees from Danone, Novartis Pharma, and Swedish Orphan Biovitrum (SOBI) payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AMARIN Germany, Amedes Holding, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, Swedish Orphan Biovitrum (SOBI), SYNLAB Holding Deutschland support for attending meetings and/or travel from AMGEN participation on a Data Safety Monitoring Board or Advisory Board from AMGEN, Daiichi Sankyo Deutschland, Novartis Pharma, Sanofi-Aventis all outside the submitted work. L G Manotvani reports support for the present manuscript from the Italian Ministry of Health, Ministero della Salute, Ricerca Corrente, IRCCS Istituto Auxologico Italiano.H R Marateb reports support for their participation in present manuscript from Beatriu de Pinos post-doctoral programme from the Office of the Secretary of Universities and Research from the Ministry of Business and Knowledge of the Government of Catalonia programme: (2020 BP 00261). S Meo reports grants or contracts from Researchers Supporting Project, King Saud University, Riyadh, Saudi Arabia (RSP-2024 R47), outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. R Moreira reports grants or contracts from CNPq (National Council for Scientific and Technological Development, scholarship registration number 316607/2021-5) outside the submitted work. S Muthu reports receiving the Luiz Vialle Award 2024 for travel support to attend Global Spine Congress 2024 from AO Spine International leadership or fiduciary role with SICOT Awards Committee, AO Spine Associate Knowledge Forum, ICRS Next-Gen Committee all outside the submitted work. S Nomura reports grants from Ministry of Education, Culture, Sports, Science and Technology of Japan (21H03203), and Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8) outside the submitted work. B Norrving reports participation on a data safety or monitoring board or advisory board with Simbec-Orion (HOVID Trial) outside the submitted work. A Oneil reports grants or contracts from the National Health and Medical Research Council via her institution (#2009295) payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Exercise & Sports Science Australia conference for an invited presentation outside the submitted work. A P Okekunle reports support for the present manuscript from National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265) support for attending meetings and/or travel from National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265) all outside the submitted work. R Ornello reports institutional grants from Novartis, consulting fees from Teva payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Eli Lilly, Novartis, Pfizer, Teva, AbbVie, and Lundbeck support for attending meetings or travel from Teva participation on a Data Safety Monitoring Board or Advisory Board with Eli Lilly leadership or fiduciary role with The Journal of Headache and Pain Editorial Board, and Frontiers in Neurology Headache and Neurogenic Pain Section receipt of payment of publication fees from Novartis and AbbVie all outside the submitted work. A Ortiz reports grants to their institute from Sanofi and Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra AstraZeneca-UAM of chronic kidney disease and electrolytes consultancy or speaker fees Advicciene , Astellas, AstraZeneca, Amicus, Amgen, Boehringer-Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo-Nordisk and Vifor Fresenius Medical Care Renal Pharma travel support from Advicciene , Astellas, AstraZeneca, Fresenius Medical Care, Boehringer-Ingelheim Bayer, Sanofi-Genzyme, Menarini, Chiesi, Otsuka, Sysmex leadership or fiduciary role, unpaid, with Council ERA. SOMANE all outside the submitted work. E Ortiz-Prado reports grants or contracts from Universidad de las Americas, Quito-Ecuador outside the submitted work. R Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Angelini, Casen Recordarti, Lundbeck, Rubio, Takeda, Servier, and Neuraxpharm support for attending meetings or travel from Angelini, Casen Recordati, Takeda, Italfarmaco, Lundbeck, and Janssen all outside the submitted work. R Passera reports participation on Data Safety Monitoring Board dello studio "Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi-treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients" - FIL, Fondazione Italiana Linfomi, Alessandria leadership or fiduciary role, unpaid, as a Member of the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris (F), and Past member 2020-2023 (biostatistician) of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC all outside the submitted work. A E Peden reports support for the present manuscript from Australian National Health and Medical Research Council (Grant Number: APP2009306). A Rane reports being a full-time employee of Agios Pharmaceuticals and owning stock and stock options, outside the submitted work. S Sacco reports grants or contracts from Novartis and Uriach consulting fees from Novartis, Allergan-AbbVie, Teva, Lilly, Lundbeck, Pfizer, NovoNordisk, Abbott, and AstraZeneca payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan-Abbvie, Teva, Lilly, Lundbeck, Pfizer, NovoNordisk, Abbott, AstraZeneca support for attending meetings and/or travel Lilly, Novartis, Teva, Lundbeck, and Pfizer leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with President European Stroke Organisation, and as Editor-in-Chief Cephalalgia receipt of equipment, materials, drugs, medical writing, gifts or other services from Allergan-AbbVie, NovoNordisk all outside the submitted work. Y L Samodra reports grants or contracts from FK Unpar, Indonesia leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Benang Merah Research Center, Indonesia all outside the submitted work. J Sanabria reports support for attending meetings and/or travel from Continuous Medical Education (CME) funds from Marshall University School of Medicine participation on a Data Safety Monitoring Board or Advisory Board with Quality officer for the Department of Surgery leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with SSAT, ACS, IHPBA, American Board of Surgery all outside the submitted work. N Scarmeas reports grants or contracts from Novo Nordisk through funding to their institution participation on a Data Safety Monitoring Board or Advisory Board with the Multicultural Healthy Diet to Reduce Cognitive Decline & AD Risk NIH Funded Study at Albert Einstein College of Medicine, and with Primus AD through a Public Private funded Phase II study in Germany all outside the submitted work. B M Schaarschmidt reports grants from Else Kroner-Fresenius Foundation, Deutsche Forschungsgemeinschaft, and PharmaCept payment or honoraria for lectures from AstraZeneca support for travel from Bayer AG all outside the submitted work. A E Schutte reports grants or contracts from National Health and Medical Research Council of Australia, and the Medical Research Future Fund, Australia consulting fees from Skylabs, Abbott, and Servier payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbott, Servier, Sanofi, Omron, Medtronic, and Aktiia support for attending meetings or travel from Medtronic and Servier leadership or fiduciary role, paid or unpaid, as Co-Chair National Hypertension Taskforce of Australia all outside the submitted work. A Sharifan reports Leadership or fiduciary role, unpaid, with Cochrane Early Career Professionals Network receipt of equipment, materials, drugs, medical writing, gifts or other services from Elsevier and Cochrane all outside the submitted work. V Sharma reports other financial or non-financial interests in DFSS (MHA)'s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, outside the submitted work. S Shrestha reports other financial or non-financial interests in the School of Pharmacy, Monash University Malaysia, and the Graduate Research Merit Scholarship, outside the submitted work. J Silva reports support for the present manuscript from Portuguese Foundation for Science and Technology through salary payments (contract with reference 2021.01789.CEECIND/CP1662/CT0014). L R Silva reports grants or contracts from project code CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE), outside the submitted work. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview healthcare partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs, Adept Field Solutions, Clinical Care options, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, and Practice Point communications and the National Institutes of Health Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events on the speakers bureau of Simply Speaking Support for attending meetings and/or travel from OMERACT as a steering committee member Participation on a Data Safety Monitoring Board or Advisory Board with the FDA Arthritis Advisory Committee Leadership or fiduciary role in other board, society, committee or advocacy group, paid as a past steering committee member of the OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, unpaid as Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and unpaid as the Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis stock or stock options in Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., Aebona Pharmaceuticals, and Charlotte's Web Holdings, Inc. and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals all outside the submitted work. J Sipila reports grants or contracts from Siun Sote Foundation and Eemil Aaltonen Foundation payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis support for attending meetings and/or travel from Lundbeck participation on a Data Safety Monitoring Board or Advisory Board with Boehringer-Ingelheim and Sandoz stock or stock options in Orion Corp all outside the submitted work. J Sundstrom reports direct or indirect stock ownership in companies (Anagram kommunikation AB, Sence Research AB, Symptoms Europe AB, MinForskning AB) providing services to companies and authorities in the health sector including Amgen, AstraZeneca, Bayer, Boehringer, Eli Lilly, Gilead, GSK, Goteborg University, Itrim, Ipsen, Janssen, Karolinska Institutet, LIF, Linkoping University, Novo Nordisk, Parexel, Pfizer, Region Stockholm, Region Uppsala, Sanofi, STRAMA, Takeda, TLV, Uppsala University, Vifor Pharma, WeMind, all outside the submitted work. A G Thrift reports grants or contracts from National Health & Medical Research Council (Australia), Heart Foundation (Australia), and Stroke Foundation (Australia) outside the submitted work. J H V Ticolau reports leadership or fiduciary role, paid or unpaid, with Benang Merah Research Center, Indonesia, outside the submitted work. S J Tromans reports grants or contracts from NHS Digital, via the Department of Health and Social Care, as payments to their institution leadership or fiduciary role, unpaid, with the Academic Secretary for the Neurodevelopmental Psychiatry Special Interest Group at the Royal College of Psychiatrists, Editorial Board for BMC Psychiatry, Advances in Autism, Advances in Mental Health and Intellectual Disability, and Progress in Neurology and Psychiatry all outside the submitted work. P Willeit reports consulting fees from Novartis Pharmaceuticals, outside the submitted work. Y Yasufuku reports grants or contracts from Shionogi & Co, through funding to their institution, outside the submitted work. M Zielinska reports other financial or non-financial interests in AstraZeneca as an employee, outside the submitted work. |
| Page Range: | pp. 973-1003 |
| Journal or Publication Title: | The Lancet. Neurology |
| Journal Index: | Pubmed |
| Volume: | 23 |
| Number: | 10 |
| Identification Number: | https://doi.org/10.1016/S1474-4422(24)00369-7 |
| ISSN: | 1474-4465 (Electronic) 1474-4422 (Linking) |
| Depositing User: | خانم ناهید ضیائی |
| URI: | http://eprints.mui.ac.ir/id/eprint/30194 |
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