Global, regional, and national epidemiology of ischemic stroke from 1990 to 2021

Abstract

Background and purpose: This study aims to examine the global, regional, and national burden of ischemic stroke from 1990 to 2021.

Method: We used data from the Global Burden of Disease (GBD) 2021 database to comprehensively assess ischemic stroke indicators globally, regionally, and in 204 countries, including incidence, deaths, disability-adjusted life years (DALYs), estimated annual percentage change (EAPC), and Joinpoint regression analysis.

Results: In 2021, there were a total of 7,804,449 cases of ischemic stroke globally (95% uncertainty interval = 6,719,760-8,943,692), with an age-standardized incidence rate (ASIR) of 92.39. This represents a declining trend compared to 1990, with an EAPC of -0.67 (95% confidence interval [CI] = -0.76 to -0.58). Mortality and DALY rates also showed a downward trend (EAPC in age-standardized mortality rate: -1.83, 95% CI = -1.92 to -1.74; EAPC in age-standardized DALY rate = -1.59, 95% CI = -1.68 to -1.50). The burden of ischemic stroke was inversely correlated with gross domestic product. Regionally, from 2014 to 2021, the Caribbean experienced the fastest increase in ASIR (annual percent change = 0.15, 95% CI = 0.13 to 0.18). Among 204 countries, North Macedonia had the highest incidence, mortality, and DALY rates. In addition to metabolic risks, particulate matter pollution and low temperatures were significant environmental and occupational risk factors for ischemic stroke. Smoking and a diet high in sodium were identified as key behavioral risk factors.

Conclusions: Ischemic stroke remains a serious global health challenge, and our results from this cross-sectional study suggest that the burden of disease remains high in Eastern Europe, East Asia, Central Asia, and Sub-Saharan Africa.

Keywords: Global Burden of Disease; epidemiology; ischemic stroke; risk factor.

FIGURE 1

Disease burden of ischemic stroke at the global level from 1990 to 2021. (a) Trends in incidence cases. (b) Trends in incidence rate. (c) Annual percent change (APC) of age‐standardized incidence rate (ASIR) of ischemic stroke globally by sex. (d) Trends in death cases. (e) Trends in death rate. (f) APC of age‐standardized mortality rate (ASMR) of ischemic stroke globally by sex. (g) Trends in disability‐adjusted life years (DALYs) cases. (h) Trends in DALY rate. (i) APC of age‐standardized death rate (ASDR) of ischemic stroke globally by sex. Asterisks indicate p < 0.05.

FIGURE 2

Disease burden of ischemic stroke by Global Burden of Disease (GBD) super region. (a) Correlation graph between gross domestic product (GDP) and age‐standardized incidence rate (ASIR). (b) Annual percentage change (APC) of ASIR of ischemic stroke in each GBD super region from 1990 to 2021. (c) Correlation graph between GDP and age‐standardized mortality rate (ASMR). (d) APC of ASMR of ischemic stroke in each GBD super region from 1990 to 2021. (e) Correlation graph between GDP and age‐standardized disability‐adjusted life year rate (ASDR). (f) APC of ASDR of ischemic stroke in each GBD super region from 1990 to 2021.

FIGURE 3

The national burden of ischemic stroke in 204 countries and territories (1990 to 2021). (a) Estimated annual percentage change (EAPC) for age‐standardized incidence rate. (b) EAPC for age‐standardized mortality rate. (c) EAPC for age‐standardized disability‐adjusted life‐year (DALY) rate.

FIGURE 4

Risk of death from ischemic stroke attributable to each risk factor in 2021. (a) Environmental and occupational risks, behavioral risks, and metabolic risks: age‐standardized mortality rate (ASMR) and population attributable fraction (PAF) of attributable ischemic stroke. (b) ASMR and PAF of ischemic stroke attributable to various environmental and occupational risks. (c) ASMR and PAF of ischemic stroke attributable to various behavioral risks. (d) ASMR and PAF of ischemic stroke attributable to various metabolic risks. LDL, low‐density lipoprotein.