Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030

Abstract

Background and objectives: Ischemic stroke (IS), 1 of the 2 main subtypes of stroke, occurs because of brain ischemia caused by thrombosis of a cerebral blood vessel. IS is one of the most important neurovascular causes of death and disability. It is affected by many risk factors, such as smoking and a high body mass index (BMI), which are also critical in the preventive control of other cardiovascular and cerebrovascular diseases. However, there are still few systematic analyses of the current and predicted disease burden and the attributable risk factors of IS.

Methods: Based on the Global Burden of Disease 2019 database, we used age-standardized mortality rate and disability-adjusted life year to systematically present the geographical distribution and trends of IS disease burden worldwide from 1990 to 2019 by calculating the estimated annual percentage change and to analyze and predict the death number of IS accounted by 7 major risk factors for 2020-2030.

Results: Between 1990 and 2019, the global number of IS deaths increased from 2.04 million to 3.29 million and is expected to increase further to 4.90 million by 2030. The downward trend was more pronounced in women, young people, and high sociodemographic index (SDI) regions. At the same time, a study of attributable risk factors of IS found that 2 behavioral factors, smoking and diet in high sodium, and 5 metabolic factors, including high systolic blood pressure, high low-density lipoprotein cholesterol, kidney dysfunction, high fasting plasma glucose, and a high BMI, are major contributors to the increased disease burden of IS now and in the future.

Discussion: Our study provides the first comprehensive summary for the past 30 years and the prediction of the global burden of IS and its attributable risk factors until 2030, providing detailed statistics for decision-making on the prevention and control of IS globally. An inadequate control of the 7 risk factors would lead to an increased disease burden of IS in young people, especially in low SDI regions. Our study identifies high-risk populations and helps public health professionals develop targeted preventive strategies to reduce the global disease burden of IS.

Figure 1. The Distribution of ASR From Ischemic Stroke in 204 Countries and Territories

(A) Regional distribution of the ASMR from ischemic stroke in 2019. (B) Regional distribution of the ASDR from ischemic stroke in 2019. (C) Regional distribution of trends in ASMR from 1990 to 2019. (D) Regional distribution of trends in ASDR from 1990 to 2019. ASDR = age-standardized disability-adjusted life year; ASMR = age-standardized mortality rate; EAPC = estimated annual percentage change.

Figure 2. Death Burden Trends From IS in 16 Age Groups and 5 SDI Regions Globally From 1990 to 2019

(A) Death burden trends from total IS globally. (B) Death burden trends in low SDI regions. (C) Death burden trends in low-middle SDI regions. (D) Death burden trends in middle SDI regions. (E) Death burden trends in high-middle SDI regions. (F) Death burden trends in high SDI regions. IS = ischemic stroke; SDI = sociodemographic index.

Figure 3. Correlation of ASMR and ASDR and Its EAPC With SDI Levels

(A) Correlation of ASMR with SDI levels in 2019. (B) Correlation of ASDR with SDI levels in 2019. (C) Correlation between the trend in ASMR (EAPC) with SDI levels from 1990 to 2019. (D) Correlation between the trend of ASDR (EAPC) and SDI levels from 1990 to 2019 (where circle size represents the number of current cases of ischemic stroke in 2019). ASDR = age-standardized disability-adjusted life year; ASMR = age-standardized mortality rate; EAPC = estimated annual percentage change; SDI = sociodemographic index.

Figure 4. Global Trends in Death Burden From IS Due to 7 Risk Factors From 1990 to 2019 Across 16 Age Groups

(A) Global trends in death burden from IS. (B) Trends in IS death burden due to smoking. (C) Trends in IS death burden due to a diet high in sodium. (D) Trends in IS death burden due to high LDL cholesterol. (E) Trends in IS death burden due to kidney dysfunction. (F) Trends in IS death burden due to high systolic blood pressure. (G) Trends in IS death burden due to high fasting plasma glucose. (H) Trends in IS death burden due to a high BMI. BMI = body mass index; IS = ischemic stroke; LDL = low density lipoprotein.

Figure 5. Prediction of Deaths From an IS From 2020 to 2030 Caused by 7 Risk Factors Worldwide

(A) Prediction of total IS deaths worldwide. (B) Prediction of IS deaths caused by smoking worldwide. (C) Prediction of IS deaths caused by a diet high in sodium worldwide. (D) Prediction of IS deaths caused by high LDL cholesterol worldwide. (E) Prediction of IS deaths caused by kidney dysfunction worldwide. (F) Prediction of IS deaths caused by high systolic blood pressure worldwide. (G) Prediction of IS deaths caused by high fasting plasma glucose worldwide. (H) Prediction of IS deaths caused by a high BMI worldwide. BMI = body mass index; IS = ischemic stroke; LDL = low density lipoprotein.