Projections of the Stroke Burden at the Global, Regional, and National Levels up to 2050 Based on the Global Burden of Disease Study 2021

Abstract

Background: Stroke is a pressing public health issue worldwide. This study aimed to forecast the future temporal trends and distribution characteristics of the global stroke burden.

Methods and results: Global data on stroke incidence, prevalence, deaths, and disability-adjusted life years between 1990 and 2021 were obtained from the GBD (Global Burden of Disease) Study 2021. The temporal trends of stroke burden were estimated using various regression models. Gross domestic product per capita was adopted as a predictor in the model to consider the impact of economic development on stroke burden. Projections of stroke burden up to 2050 were generated using the optimal model selected based on the Akaike information criterion, encompassing global, World Bank income levels, national levels, and sex-age groups. In 2050, we projected 21.43 million stroke cases, 159.31 million survivors, 12.05 million deaths, and 224.86 million disability-adjusted life years due to stroke globally. From 2021 to 2050, there was a declining trend in the global age-adjusted stroke rates, with -7% in incidence, -4% in prevalence, -28% in deaths, and -28% in disability-adjusted life years. Upper-middle-income countries were projected to have the most severe stroke burden, followed by lower-middle-income countries, low-income countries, and high-income countries. The stroke burden in over half of the 204 countries and territories was expected to be alleviated from 2022 to 2050. Men and older women worldwide bear higher burden.

Conclusions: Stroke remains a serious global health challenge, especially in low-income and middle-income countries. Targeted implementation of prevention and interventions is imperative across diverse demographic groups.

Keywords: Global Burden of Disease; epidemiology; gross domestic product; projections; stroke.

Figure 1. The predictive performance of various models worldwide was evaluated during the testing period (2012–2021): incidence (A), prevalence (B), deaths (C), and DALYs (D).

The RMSE reflects the average deviation between the predicted and observed values in the evaluation years (2012–2021). DALYs indicate disability‐adjusted life years; and RMSE, root mean square error.

Figure 2. The historical trends and future projections of global stroke from 1990 to 2050: incidence (A), prevalence (B), deaths (C), and DALYs (D).

DALYs indicate disability‐adjusted life years.

Figure 3. Age‐adjusted stroke rates and corresponding relative changes in 4 regions with World Bank income levels from 2021 to 2050: incidence (A), prevalence (B), deaths (C), and DALYs (D).

DALYs indicate disability‐adjusted life years.

Figure 4. Projected average annual percentage change in the age‐adjusted rates of stroke in 204 countries from 2021 to 2050: incidence (A), prevalence (B), deaths (C), and DALYs (D).

AAPC indicates average annual percentage change; and DALYs, disability‐adjusted life years.

Figure 5. Absolute number of stroke by age and sex groups in 1990, 2021, and 2050 reference forecast: incidence (A), prevalence (B), deaths (C), and DALYs (D).

DALYs indicates disability‐adjusted life years.

Figure 6. Projected change in absolute number of stroke by age group in four regions with World Bank income levels (2050 vs 2021): incidence (A), prevalence (B), deaths (C), and DALYs (D).

DALYs indicates disability‐adjusted life years.