Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019

Abstract

Data sources: The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019.

Background: To describe burden, and to explore cross-country inequalities according to socio-demographic index (SDI) for stroke and subtypes attributable to diet.

Methods: Death and years lived with disability (YLDs) data and corresponding estimated annual percentage changes (EAPCs) were estimated by year, age, gender, location and SDI. Pearson correlation analysis was performed to evaluate the connections between age-standardized rates (ASRs) of death, YLDs, their EAPCs and SDI. We used ARIMA model to predict the trend. Slope index of inequality (SII) and relative concentration index (RCI) were utilized to quantify the distributive inequalities in the burden of stroke.

Results: A total of 1.74 million deaths (56.17% male) and 5.52 million YLDs (55.27% female) attributable to diet were included in the analysis in 2019.Between 1990 and 2019, the number of global stroke deaths and YLDs related to poor diet increased by 25.96% and 74.76% while ASRs for death and YLDs decreased by 42.29% and 11.34% respectively. The disease burden generally increased with age. The trends varied among stroke subtypes, with ischemic stroke (IS) being the primary cause of YLDs and intracerebral hemorrhage (ICH) being the leading cause of death. Mortality is inversely proportional to SDI (R = -0.45, p < 0.001). In terms of YLDs, countries with different SDIs exhibited no significant difference (p = 0.15), but the SII changed from 38.35 in 1990 to 45.18 in 2019 and the RCI showed 18.27 in 1990 and 24.98 in 2019 for stroke. The highest ASRs for death and YLDs appeared in Mongolia and Vanuatu while the lowest of them appeared in Israel and Belize, respectively. High sodium diets, high red meat consumption, and low fruit diets were the top three contributors to stroke YLDs in 2019.

Discussion: The burden of diet-related stroke and subtypes varied significantly concerning year, age, gender, location and SDI. Countries with higher SDIs exhibited a disproportionately greater burden of stroke and its subtypes in terms of YLDs, and these disparities were found to intensify over time. To reduce disease burden, it is critical to enforce improved dietary practices, with a special emphasis on mortality drop in lower SDI countries and incidence decline in higher SDI countries.

Keywords: Dietary risks; Global burden of disease (GBD); Health inequality; Mortality; Stroke; Years lived with Disability (YLDs).

Fig. 1

a–d Global burden of stroke attributable to diet from 1990 to 2050. e & f Global burden of subtypes attributable to diet from 1990 to 2019 by gender. g & h Global burden of stroke and subtypes attributable to diet by age in 2019. YLDs years lived with disability, ASMR Age-standardized mortality rate, ASYR Age-standardized YLDs rate

Fig. 2

The correlations between ASMR (a), ASYR (c) and SDI of 204 countries and territories in 2019. The correlations between EAPCs of ASMR(b), ASYR(d)from 1990–2019 and SDI in 2019, the size of circle represents the numbers of stroke deaths or YLDs in 2019. YLDs years lived with disability, ASMR Age-standardized mortality rate, ASYR Age-standardized YLDs rate, EAPC estimated annual percentage change, SDI socio-demographic index

Fig. 3

The EAPCs of ASMR and ASYR of diet-attributable stroke and subtypes from 1990 to 2019. ASMR age-standardized mortality rate, ASYR age-standardized YLDs rate, YLDs years lived with disability, EAPC estimated annual percentage change, SDI socio-demographic index

Fig. 4

The global distribution of ASMR (a) and ASYR(b) of stroke attributable to diet for both genders in 204 countries and territories in 2019, and the corresponding EAPCs of ASMR(c) and ASYR(d) from 1990 to 2019. ASMR age-standardized mortality rate, ASYR age-standardized YLDs rate, YLDs years lived with disability, EAPC estimated annual percentage change

Fig. 5

Health inequality regression curves and concentration curves for the YLDs of stroke (a &b), IS (c & d), ICH (e & f), and SAH (g & h) worldwide, 1990 and 2019. YLDs years lived with disability, IS ischemic stroke, ICH intracerebral hemorrhage, SAH subarachnoid hemorrhage

Fig. 6

Proportion of stroke YLDs attributable to specific dietary components, for global,5 SDI and 21 GBD regions, 2019. YLDs years lived with disability, SDI socio-demographic index

Fig. 7

Leading dietary risks of YLDs of stroke in 1990, 2010 and 2019 with percentage change of ASYR by subtypes and genders. ASYR Age-standardized YLDs rate, YLDs years lived with disability