Stroke burden and rehabilitation need in Eastern Europe

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Abstract
Background. Despite declining stroke mortality in Eastern European countries, the burden of stroke measured as years lived with disability (YLD) has not shown a decreasing trend, giving rise to the so-called “rehabilitation paradox”. Objective: To assess trends in the burden of stroke in Lithuania, Russia, Moldova, Estonia, and Czechia from 2010 to 2021, and to model neurorehabilitation needs and workforce shortages. Material and methods. A secondary analysis of data from the Global Burden of Disease Study (GBD) 2021 was conducted. Both absolute YLD counts and YLD rates per 100,000 population were examined. The estimated annual percentage change (EAPC) for 2010–2021 was calculated. Based on GBD data, the demand for neurorehabilitation services was modeled and workforce shortages were estimated for the countries under analysis. Results. In 2021, the highest YLD rates per 100,000 population were observed in Lithuania (333.3) and Russia (305.8). A decline in YLD was identified in Estonia (EAPC –0.9%; –9.7% from 2010 to 2021) and Czechia (EAPC –1.6%; –14.6% from 2010 to 2021). In Russia, the absolute YLD burden increased by 2.2% (up to 454.3 thousand individuals). The shortage of rehabilitation professionals was estimated at 14,855 in Russia, 366 in Moldova, and 282 in Lithuania. Sensitivity analysis for 2010–2019 confirmed the observed trends; the impact of COVID-19 was found to be moderate. Conclusion. A rehabilitation gap persists across all five countries. Scaling up neurorehabilitation services in accordance with the standards of the European Stroke Organisation and the World Health Organization is required.

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