Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study

Abstract

Stroke remains a critical global health issue, significantly impacting India with substantial contributions to mortality and disability. This study comprehensively analyses stroke incidence, mortality, and disability-adjusted life years (DALYs) across India from 1990 to 2021, using the latest Global Burden of Disease (GBD) 2021 data. We evaluate how Universal Health Coverage (UHC), health expenditure, human development index (HDI), and gross national income (GNI) influence stroke outcomes. Our findings reveal significant regional disparities, with higher stroke rates in urban areas and states like Goa and Kerala. Higher health expenditure and HDI are linked to lower stroke rates, while higher GNI per capita correlates with increased stroke incidence, likely due to lifestyle changes. Risk factors include air pollution, tobacco use, dietary risks, and high blood pressure. Air pollution notably impacts stroke mortality in Bihar and Jharkhand, while tobacco use is a major risk factor in Mizoram and Manipur. Dietary risks and hypertension are prevalent in Maharashtra and Jammu & Kashmir. The study highlights the need for targeted public health strategies addressing regional disparities and socioeconomic factors. Policymakers should focus on lifestyle modification programs, public awareness campaigns, and enhanced access to quality stroke care to reduce stroke-related morbidity and mortality effectively.

Keywords: Global burden of disease; Regional disparities; Risk factors; Stroke burden; Universal health coverage.

Fig. 1

Stroke incidence rate (new cases per 100,000 population) by age, 1990–2021 in India. Point represents mean estimates and error bars represent 95% lower and upper limit uncertainty interval.

Fig. 2

Incidence rate (per 100,000 population) of stroke in 2021 in India by state.

Fig. 3

Deaths rate (per 100,000 population) of stroke in 2021 in India by state.

Fig. 4

DALYs rate (per 100,000 population) of stroke in 2021 in India by stat.

Fig. 5

Percentage change in stroke deaths and DALYs number by risk factors between 1990 and 2021.

Fig. 6

Percentage of stroke deaths attributed to air pollution in Indian states, 2021.

Fig. 7

Percentage of stroke deaths attributed to tobacco use in Indian states, 2021.

Fig. 8

Percentage of stroke deaths attributed to dietary risks in Indian states, 2021.

Fig. 9

Percentage of stroke deaths attributed to high systolic blood pressure in Indian states, 2021.

Fig. 10

Stroke burden and universal health coverage.

Fig. 11

Regression result graphs of stroke burden in India. Regression results can be found in Supplementary Table S1, where a color dot (.) represents the coefficient estimate, and an error bar shows the 95% confidence interval with lower and upper limits.