Stroke

Stroke is an Australia's health topic

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Stroke occurs when a blood vessel supplying blood to the brain either suddenly becomes blocked (ischaemic stroke) or ruptures and begins to bleed (haemorrhagic stroke). Either may result in part of the brain dying, leading to sudden impairment that can affect a number of functions. Stroke often causes paralysis of parts of the body normally controlled by the area of the brain affected by the stroke or speech problems and other symptoms, such as difficulties with swallowing, vision and thinking.

Stroke can be prevented because many of its risk factors are modifiable. These include biomedical risk factors such as high blood pressure, insufficient physical activity, overweight and obesity, and tobacco smoking.

Stroke contributes to premature death, disability, and preventable hospitalisations. As a result of the substantial impact of stroke on the Australian population, a National Strategic Action Plan for Heart Disease and Stroke has been developed. The action plan aims to reflect priorities and identify implementable actions to reduce the impact of stroke in the community.

How common is stroke?

In 2018, an estimated 387,000 people aged 15 years and over – 214,000 males and 173,000 females – had had a stroke at some time in their lives, based on self-reported data from the Australian Bureau of Statistics (ABS) 2018 Survey of Disability, Ageing and Carers (ABS 2019, AIHW 2021c). The estimated prevalence of stroke was similar in 2003 (1.7%) and 2018 (1.3%) (ABS 2019; AIHW 2013).

In 2020, there were around 39,500 stroke events (21,000 among males and 18,500 among females) – more than 100 every day. The stroke event rate fell by one quarter (27%) between 2001 and 2020, from an age-standardised rate of 169 to 124 per 100,000 population (Figure 1).

Figure 1: Stroke events, by sex, 2001–2020

The chart provides the number and rate of stroke events between 2001 and 2020. The age-standardised rate of stroke events decreased by 26% for males (from 194 to 144 per 100,000 population), and by 29% for women (from 148 to 105 per 100,000 population).

Impact

Deaths

In 2020, stroke was recorded as the underlying cause of 8,200 deaths, accounting for 5.1% of all deaths in Australia. 

Stroke was one of the 5 leading causes of death in Australia – on average, 22 Australians died of stroke each day in 2020.

Rates of death increase with age – in 2020, rates among males and females aged 85 and over (690 and 900 per 100,000 population) were 4–5 times as high as rates among males and females aged 75–84 years (175 and 165 per 100,000 population).

Between 1980 and 2020, death rates for stroke have fallen by three-quarters – from 110 to 23 per 100,000 population for males, and from 99 to 24 per 100,000 population for females. The rate of decline has remained steady in people aged 75 and over but has slowed among younger age groups (Figure 2).

Falling stroke death rates have been driven by a number of factors, including improvements in some risk factors such as lower rates of tobacco smoking, an increased use of blood pressure–lowering drugs, treatment to prevent blood clots, access to stroke units in hospitals and other advances in medical care (AIHW 2013, 2021c).

See ‘Chapter 4 Changing patterns of mortality in Australia since 1900’ in Australia’s health 2022: data insights.

 Figure 2: Stroke deaths among people aged 55-64, 65-74, 75-84 and 85 and over, by sex, 1980 to 2020

The chart shows the number and rate of deaths from stroke for males and females aged 55-64, 65-74, 75-84 and 85 and over, from 1980 to 2020. Stroke death rates fell substantially in each age group – for example, from 938 to 175 deaths per 100,000 population for men aged 75–84, and from 871 to 165 for women aged 75–84.

Burden of disease

Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury and is measured using disability-adjusted life years (DALY). One DALY is equivalent to one year of healthy life lost.

In 2018, stroke accounted for 2.4% of the total burden of disease in Australia and was the 11th leading specific cause of disease burden.

Stroke ranks high in disease burden among older people – for age 85 and over, it accounted for 5.5% of the burden in males and 6.6% of the burden in females.

The total burden of disease due to stroke decreased by 44% between 2003 and 2018, from 7.4 to 4.2 DALY per 1,000 population. This included a 46% decline in the fatal burden and a 19% decline in the non-fatal burden (AIHW 2021a).

See Burden of disease.

Expenditure

In 2018–19, the estimated health system expenditure on stroke was more than $660 million. The greatest cost was for public hospital admitted patient services ($364.2 million) followed by private hospital services ($115.0 million) (AIHW 2021b).

See Health expenditure.

Treatment and management

Emergency departments

There were 41,100 presentations to Australian public hospital Emergency Departments with a principal diagnosis of stroke in 2020–21. Of these, 34,000 (83%) were admitted to the hospital to which they presented, 4,400 (11%) were referred to another hospital for admission, and 2,200 (5%) departed without being admitted or referred (AIHW 2022d).

Hospitalisations

In 2020–21, there were 41,300 acute care hospitalisations with a principal diagnosis of stroke, at a rate of 161 per 100,000 population. Acute care hospitalisation rates were higher among males than females (1.4 times as high), and most hospitalisations (73%) were for people aged 65 and over.

Between 2000–01 and 2020–21, the age-standardised rate of hospitalisation for acute care stroke fell by 23%, from 170 to 130 per 100,000 population.

See Hospitals.

Rehabilitation

Stroke rehabilitation helps stroke survivors to relearn and maintain their skills and functioning. It also seeks to protect them from developing new medical problems.

  • In 2019–20, stroke patients in hospital rehabilitation care had an average length of stay of 14 days.
  • Of a group of 2,800 stroke survivors assessed before hospital discharge in 2019, 64% were referred for further rehabilitation in the community (Stroke Foundation 2020).

Variation between population groups

The impact of stroke varies between population groups, with age-standardised rates higher among Aboriginal and Torres Strait Islander people than among non-Indigenous Australians for both hospitalisation (1.7 times as high) and death (1.8 times as high) (Figure 3).

Age-standardised death rates and burden of disease were 1.1 and 1.2 times as high in Remote and very remote areas as in Major cities. The rate of death for stroke was 1.4 times as high in the lowest socioeconomic areas as in the highest.
 

The figure shows the age-standardised rate ratio of stroke prevalence (2018), hospitalisation (2020–21), death (2020) and burden of disease (2018) among selected population groups.

Rates were higher among Aboriginal and Torres Strait Islander people than among non-Indigenous Australians for both hospitalisation (1.7 times as high) and death (1.8 times as high). Death rates and burden of disease were 1.1 and 1.2 times as high in Remote and very remote areas as in Major cities. The rate of death for stroke was 1.4 times as high in the lowest socioeconomic areas as in the highest.

COVID-19 and stroke

People who have had a stroke are at a higher risk of severe symptoms and complications from COVID-19. People with COVID-19 are also at greater risk of stroke (Nannoni et al. 2021).

The first wave of the pandemic negatively impacted access to specialised stroke units in hospitals, with fewer resources available for treatment, leading to concerns about reduced quality of care for stroke patients (Cadilhac et al. 2022).

Australian Bureau of Statistics (ABS) provisional mortality data suggest that the COVID-19 pandemic in Australia did not lead to an increase in mortality for cerebrovascular diseases (including stroke). There were 9,046 deaths due to cerebrovascular diseases during 2020, and 9,116 in 2021 – both below the historical average of 9,748. In January–September 2022, there were 7,105 deaths due to cerebrovascular disease, similar to the historical average of 7,234 (ABS 2022).

Where do I go for more information?

For more information on stroke, see: