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. 2025 Mar 19:16:1492691.
doi: 10.3389/fneur.2025.1492691. eCollection 2025.

Comprehensive analysis of the ischemic stroke burden at global, regional, and national levels (1990-2021): trends, influencing factors, and future projections

Haonan Zhao #  1 , Sikai Lu #  2 , Yang Jie  1 , Wu Chao  1 , Wenxia Zhu  1 , Dongya Huang  1
Affiliations

Comprehensive analysis of the ischemic stroke burden at global, regional, and national levels (1990-2021): trends, influencing factors, and future projections

Haonan Zhao et al. Front Neurol. .

Abstract

Background and purpose: Estimating the global burden of ischemic strokes (IS) is crucial for enhancing prevention and control strategies.

Methods: We collected four epidemiological indicators-prevalence, incidence, deaths, and disability-adjusted life years (DALYs)-for ischemic stroke (IS) from the Global Burden of Disease (GBD) database, which covers the years 1990 to 2021. Our research analyzed the features of the IS burden and described the trends of these four indicators.

Results: The Joinpoint and age-period-cohort models reflected the changing trends in age-standardized indicators. Decomposition analysis examined the factors influencing each epidemiological indicator. The Bayesian Age-Period-Cohort (BAPC) model detailed changes in the number and rate of IS from 1990 to 2021 and projected trends through 2046. The Norpred model was used to verify the stability of the BAPC prediction results. The prevalence, incidence, deaths, and DALYs due to IS generally exhibited a downward trend. However, the predictions indicated that while the age-standardized incidence rate decreased from 1990 to 2015, this trend reversed between 2016 and 2021 and is expected to continue until 2046. This reversal is likely driven by factors such as population aging, given that age is a strongly correlated risk factor for IS. The IS burden was negatively associated with socio-demographic index (SDI) levels, with high systolic blood pressure identified as the largest risk factor for DALYs and deaths. The consistency between the BAPC and Norpred models enhances the reliability of these projections.

Conclusion: Over the past two decades, trends in prevalence, incidence, deaths, and DALYs have all declined. However, projections suggest that incidence will show an upward trend over the next two decades.

Keywords: Joinpoint regression; forecasting analysis; global burden of disease study; ischemic stroke; preventive health services; trends analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The change trend of incidence (A), prevalence (B), death (C), and DALYs (D) by age in 2021.
Figure 2
Figure 2
The change trend of incidence (A), prevalence (B), death (C), and DALYs (D) from 1990 to 2021.
Figure 3
Figure 3
Changes in the ASIR, ASPR, ASMR, and DALYs of gout globally and across different SDI regions. (A) ASIR, (B) ASPR, (C) ASMR, and (D) DALYs.
Figure 4
Figure 4
PAF of the IS in 2021 (A,B) and 1990 (C,D).
Figure 5
Figure 5
Decomposition analysis of IS incidence from 1990 to 2021.
Figure 6
Figure 6
Frontier analysis using ASDR. The solid black line indicates the frontier, while the dots indicate the countries and regions. The red dots show a downward trend in IS ASDR from 1990 to 2021, whereas the blue dots indicate the opposite trend.
Figure 7
Figure 7
Projected ASIR for IS by gender (both men and women) from 1990 to 2046 based on the BAPC model (A) and Norpred (B).
See this image and copyright information in PMC

References

    1. GBD 2019 Stroke Collaborators . Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol. (2021) 20:795–820. doi: 10.1016/S1474-4422(21)00252-0 - DOI - PMC - PubMed
    1. Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, et al. . Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet. (2019) 394:1145–58. doi: 10.1016/S0140-6736(19)30427-1, PMID: - DOI - PMC - PubMed
    1. Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, et al. . Prevention of stroke: a global perspective. Lancet Lond Engl. (2018) 392:1269–78. doi: 10.1016/S0140-6736(18)31269-8 - DOI - PubMed
    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. . American Heart Association Council on epidemiology and prevention statistics committee and stroke statistics subcommittee. Heart disease and stroke Statistics-2020 update: a report from the American Heart Association. Circulation. (2020) 141:e139–596. doi: 10.1161/CIR.0000000000000757, PMID: - DOI - PubMed
    1. Qin C, Yang S, Chu YH, Zhang H, Pang XW, Chen L, et al. . Signaling pathways involved in ischemic stroke: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther. (2022) 7:215. doi: 10.1038/s41392-022-01064-1, PMID: - DOI - PMC - PubMed

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