stroke incidence in Japan, Singapore, and Korea, between 1990 and 2010;2 in fact, the substantial decline in the age-adjusted stroke incidence in Japan began in the 1960s, due to a decrease in severe hypertension and current smoking.45 Impressive falls in the DALYs lost were observed in Japan, Singapore, Korea, and Taiwan (Table 5).2 The decrease in high mortality, incidence and morbidity, observed predominantly in high-income countries, reflects the significant impact of the economic status of a country on health. This pattern of high incidence and falling mortality is likely to raise the prevalence of stroke in those countries. This problem may be compounded by the presence of fewer caregivers, as these countries also have low birth rates. In South-Asian counties such as India, Pakistan, and Bangladesh, and in developing countries in South-East Asia, such as Cambodia, Indonesia, Lao PDR, and Malaysia, with the better control of infectious diseases, life expectancy will be prolonged. With the economic transition of these countries, towards achieving “developed country” status, risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, obesity, and cigarette smoking will become more prevalent, raising the incidence of stroke. However, due to insufficient healthcare facilities in these developing countries, the mortality will be high, and the number of disabled survivors will also rise. Limitations and strengths Our study has several limitations. The data from the WHO, though comprehensive and available for almost all countries, Table 5. Age and sex-standardized disability-adjusted life years lost, 1990–2010 Country Disability-adjusted life years lost /100,000 people 1990 2005 No. 3 / September 2017 are based on routinely available data in those countries. There may be variations in the comprehensiveness of the data collection and data reporting, accuracy of the cause of death, and extent of disability. Prevalence and incidence studies, though community-based, were performed at different time points, involved varying ages (especially prevalence studies), used differing methods to screen and assess cases, and thus are not directly comparable. The data were not granular enough to allow for a systematic review. Data were unavailable for a number of countries. Hospital-based studies are prone to selection bias, with a significant flaw in their representativeness; they were performed at different time points; they used varying definitions for the risk factors; and few had 100% brain scan rates. Nation-wide data with good representativeness would be preferred—at present, such data are only available from the country—wide hospital-based registry in China.29 However, our paper has several strengths. It includes up-todate reliable data from the excellently-performed GBD study and WHO, as well as large, recently-conducted studies from most Asian countries. Data on South-East Asia are available, alongside data on South and East Asia. The paper summarizes and compares, in an easily readable manner, key epidemiological data on stroke that could be helpful to clinicians, researchers and healthcare planners. Conclusions Stroke is a major healthcare problem in South, East, and South-East Asia. With a majority of the world’s population living in the developing countries of these regions, the the global burden of stroke will have the largest contribution from Asia. In these countries, there are disparities in the healthcare provisions, and this will continue to pose a challenge to disease control. Governments and healthcare workers need to work together, with an informed public, to stem this growing epidemic. As life expectancy increases, with the aging of Asian populations and reduction in mortality due to infectious diseases, and the rise in the prevalence of vascular risk factors among economies in transition, the stroke burden in Asia will surely rise disease and its risk factors in Japanese: half-century data from the Hisayama study (1961-2009). Circulation 2013;128:1198-1205. 11. Xu T, Bu X, Li H, Zhang M, Wang A, Tong W, et al. Smoking, heart rate, and ischemic stroke: a population-based prospective cohort study among Inner Mongolians in China. Stroke 2013;44:2457-2461. 12. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: pa Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions Vasu Saini, MD, Luis Guada, MD, and Dileep R. Yavagal, MD Neurology® 2021;97:S6-S16. doi:10.1212/WNL.0000000000012781 Correspondence Dr. Yavagal dyavagal@med.miami.edu Abstract Purpose of the Review To provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide. Recent Findings Randomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients. Summary Stroke is the second leading cause of both disability and death worldwide,