Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021

Xin-Yu Li; Xiang-Meng Kong; Cheng-Hao Yang; Zhi-Feng Cheng; Jia-Jie Lv; Hong Guo; Xiao-Hong Liu

doi:10.1016/j.eclinm.2024.102758

Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021

EClinicalMedicine. 2024 Jul 27:75:102758. doi: 10.1016/j.eclinm.2024.102758. eCollection 2024 Sep.

Authors

Xin-Yu Li^{1

2}, Xiang-Meng Kong², Cheng-Hao Yang^{1

3}, Zhi-Feng Cheng³, Jia-Jie Lv^{3

4}, Hong Guo⁵, Xiao-Hong Liu¹

Affiliations

¹ Department of Neurology, Shanghai Putuo People's Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Vascular Surgery, Shanghai Putuo People's Hospital, School of Medicine, Tongji University, Shanghai, China.
⁴ Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.
⁵ Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.

Abstract

Background: Ischemic stroke remains a major contributor to global mortality and morbidity. This study aims to provide an updated assessment of rates in ischemic stroke prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, specifically focusing on including prevalence investigation alongside other measures. The analysis is stratified by sex, age, and socio-demographic index (SDI) at global, regional, and national levels.

Methods: Data for this study was obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). To quantify temporal patterns and assess trends in age-standardized rates of ischemic stroke prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs, estimated annual percentage changes (EAPCs) were computed over the study period. The analyses were disaggregated by gender, 20 age categories, 21 GBD regions, 204 nations/territories, and 5 SDI quintiles. R statistical package V 4.4.2 was performed for statistical analyses and plot illustrations.

Findings: In 2021, the global burden of ischemic stroke remained substantial, with a total of 69,944,884.8 cases with an ASPR of 819.5 cases per 100,000 individuals (95% UI: 760.3-878.7). The ASIR was 92.4 per 100,000 people (95% UI: 79.8-105.8), while the ASDR was 44.2 per 100,000 persons (95% UI: 39.3-47.8). Additionally, the age-standardized DALY rate was 837.4 per 100,000 individuals (95% UI: 763.7-905). Regionally, areas with high-middle SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALY rates, whereas high SDI regions had the lowest rates. Geospatially, Southern Sub-Saharan Africa had the highest ASPR, while Eastern Europe showed the highest ASIR. The greatest ASDR and age-standardized DALY rates were observed in Eastern Europe, Central Asia, as well as North Africa, and the Middle East. Among countries, Ghana had the highest ASPR, and North Macedonia had both the highest ASIR and ASDR. Furthermore, North Macedonia also exhibited the highest age-standardized DALY rate.

Interpretation: Regions with high-middle and middle SDI continued to experience elevated ASPR, ASIR, ASDR and age-standardized DALY rates. The highest ischemic stroke burden was observed in Southern Sub-Saharan Africa, Central Asia, Eastern Europe, and the Middle East.

Funding: None.

Keywords: Disability-adjusted life years; Global burden of disease; Incidence; Ischemic stroke; Prevalence.