with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap. From the Departments of Neurology (V.S., L.G., D.R.Y.) and Neurosurgery (V.S., D.R.Y.), Jackson Memorial Hospital and University of Miami Miller School of Medicine, FL. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. S6 Copyright © 2021 American Academy of Neurology Copyright © 2021 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Stroke is the second leading cause of both disability and death worldwide1 and poses a staggering burden at both individual and societal levels. Whereas advances in the treatment of hemorrhagic stroke (HS) have been slow, IV thrombolysis (IVT) and more recently mechanical thrombectomy (MT) for large vessel occlusion (LVO) have changed our ability to prevent long-term disability from acute ischemic stroke (AIS) in eligible patients. Outcomes from IVT and MT are highly timesensitive and rapid access to these AIS interventions is lagging, especially from the global perspective. This review examines the global burden of stroke and the dramatic geographic disparities in stroke incidence as well in access to AIS interventions. Ongoing and planned approaches to address this are discussed. Global Epidemiology of Stroke In 2010, the estimated number of incident ischemic strokes (IS) and HS across the globe was 11.6 million and 5.3 million, respectively; 63% of IS and 80% of HS occurred in low- and middle-income countries.2,3 In 2016, the number of incident new strokes increased to 13.7 million (95% confidence interval [CI] 12.7–14.7; Figure 1).1 In the same year, 5.5 million deaths worldwide were attributed to stroke; IS and HS accounted for 2.7 million and 2.8 million deaths, respectively.1 A geographic distribution of the burden of stroke can be constructed with methodologic limitations including variability in research approaches for reporting incidence of stroke in different countries as well as a lack of information for many (Table 1). Worldwide stroke prevalence in 2016 was 80.1 million (95% CI 74.1–86.3): 41.1 million (38.0–44.3) in women and 39.0 million (36.1–42.1) in men.1 In the United States, the prevalence of stroke is about 3% in adults 20 years or older, which accounts for ≈7 million strokes in the population.4 Annually, ≈795,000 people experience a new or recurrent stroke in the United States; ≈610,000 of these are first time strokes.4 This translates to a global stroke prevalence and incidence of ≈1,322 and 156 per 100,000 persons, respectively, in 2016, and US stroke prevalence and incidence of ≈2,320 and 184 per 100,000 persons, respectively, in 2016.1,5 The stroke case-fatality rate at 30 days ranged from ≈10% in Dijon, France (2000–2004) to as high as 42% in Kolkata, India (2003–2010).6 This highlights the disparity in availability of resources to mitigate stroke burden and hence outcomes of stroke around the world. Figure 2 highlights the disproportionate distribution of age-standardized stroke incidence by country across the globe. Stroke is the second leading cause of disability and accounted for ≈116 million global disabilityadjusted life-years (DALYs) lost in 2016.1 From 1990 to 2010, although the age-standardized mortality rates for IS and HS decreased, the absolute number of people with incident IS and HS increased by 37% and 47%, respectively; the number of associated deaths increased by 21% and 20%, respectively; and DALYs lost increased by 18% and 14%, respectively.3 Recent data from 2010 to 2017 continue to show alarming increase in stroke incidence and mortality by 5.3% each, prevalence by 19.3%, and DALYs lost by 2.7%.7 Most of the burden of this absolute increase in incidence of strokes is borne by low- and middle-income countries.3 In a Figure 1 Global Incidence of Stroke and Ischemic Stroke for All Ages and Both Sexes, From 1990 to 2017 Source: Institute for Health Metrics and Evaluation; ghdx.healthdata.org/ gbd-results-tool. University of Washington, Seattle; 2015.5 Glossary AHA/ASA = American Heart Association/American Stroke Association; AIS = acute ischemic stroke; ASPECTS = Alberta Stroke Program Early CT Score; CI = confidence interval; DALY = disability-adjusted life-year; ED = emergency department; HS = hemorrhagic stroke; IS = ischemic stroke; IVT = IV thrombolysis; LVO = large vessel occlusion; MCA = middle cerebral artery; mRS = modified Rankin Scale; MSU = mobile stroke unit; MT = mechanical thrombectomy; MT2020+ = Mission Thrombectomy 2020+; mTICI = modified Thrombolysis in Cerebral Infarction; NINDS = National Institute of Neurological Disorders and Stroke; OR = odds ratio; QALY = quality-adjusted life-year; RCT = randomized