Epidemiology and future trend predictions of ischemic stroke based on the global burden of disease study 1990-2021

Abstract

Background: Visualizing the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 and predicting future disease burdens at global, regional, and national levels can help health policymakers develop evidence-based ischemic stroke (IS) prevention and cure strategies.

Methods: We stratify epidemiological parameters by sex, age, the World Bank's classification of economies, and sociodemographic index (SDI) levels. We use frontier analysis to assess whether the burden of ischemic stroke (IS) in each country aligns with its level of economic development. We apply the Autoregressive Integrated Moving Average (ARIMA) model and the Bayesian age-period-cohort (BAPC) model to predict the burden of IS over the next 15 years.

Results: Here we show that IS accounts for 69.9 million prevalent cases, 7.8 million incident cases, 3.6 million deaths, and 70.4 million DALYs in 2021. In men, the global DALY rate of IS increases up to age 90-94 years and then decreases; however, for women, the rate increases up to the oldest age group (≥95 years). Regionally, we find that the association between the SDI and the age-standardized DALY rate of IS starts relatively flat, with a small peak up to a sociodemographic index of about 0.7, and then declines rapidly. Factors contributing most to the DALY rates for IS are high systolic blood pressure, high LDL cholesterol, and air pollution.

Conclusions: The disease burden of IS in medium-high SDI countries is still high, which means we could not meet the Sustainable Development Goal targets by 2030. Countries should formulate prevention and control measures suitable for their national conditions based on risk factors.

Fig. 1. Global variation in ischemic stroke prevalence.

Age-standardized point prevalence of ischemic stroke (IS) per 100,000 population in 2021, by country (n = global dataset). Data are generated from the Global Burden of Disease (GBD) results tool (https://ghdx.healthdata.org/gbd-results-tool). ASPR Age-Standardized Prevalence Rate; IS Ischemic Stroke. The source data for Fig. 1 are provided in Supplementary Data 9. Actual sizes: Prevalence values ranged from 200 to over 1800 per 100,000 population across countries.

Fig. 2. Age and sex distribution of ischemic stroke cases.

Number of prevalent cases globally and prevalence of ischemic stroke (IS) per 100,000 population by age and sex in 2021 (n = global dataset). Lines indicate prevalent cases with 95% uncertainty intervals for men and women. Data are generated from the GBD results tool (https://ghdx.healthdata.org/gbd-results-tool). IS Ischemic Stroke. The source data for Fig. 2 are provided in Supplementary Data 10. Actual sizes: The number of prevalent cases peaked at around 1.8 million in men and 2.0 million in women aged 70–74 years. Prevalence rates ranged from <100 to over 2500 per 100,000 across age groups.

Fig. 3. Burden of ischemic stroke by country development level.

Age-standardized disability-adjusted life years (DALYs) rates of ischemic stroke (IS) for 204 countries and territories by Socio-demographic Index (SDI) in 2021. Expected values based on SDI and disease rates in all locations are shown as the black line. Each point represents the observed age-standardized DALYs rate for each country (n = 204). Data are generated from the GBD results tool (https://ghdx.healthdata.org/gbd-results-tool). DALYs Disability-Adjusted Life Years, SDI Socio-Demographic Index, ASR Age-Standardized Rate, IS Ischemic Stroke. The source data for Fig. 3 are provided in Supplementary Data 3. Actual sizes: Observed DALY rates ranged from approximately 200 to over 1400 per 100,000 population.

Fig. 4. Key risk factors contributing to ischemic stroke burden.

Percentage of disability-adjusted life years (DALYs) due to ischemic stroke (IS) attributable to each risk factor by sex for the 21 GBD regions in 2021 (n = 21 regions). Data are generated from the GBD results tool (https://ghdx.healthdata.org/gbd-results-tool). DALYs = Disability-Adjusted Life Years; LDL = Low-Density Lipoprotein; IS = Ischemic Stroke. The source data for Fig. 4 are provided in Supplementary Data 12. Actual sizes: The most significant contributors were high systolic blood pressure (up to 60%), high LDL cholesterol (up to 40%), and ambient particulate matter pollution (up to 30%).

Fig. 5. Health system performance in managing ischemic stroke burden.

Frontier analysis based on Socio-demographic Index (SDI) and ischemic stroke (IS) DALYs rate in 2021 (n = global dataset). Data are generated from the GBD results tool (https://ghdx.healthdata.org/gbd-results-tool). DALYs Disability-Adjusted Life Years, SDI Socio-Demographic Index, IS Ischemic Stroke. The source data for Fig. 5 are provided in Supplementary Data 13. Actual sizes: Effective difference values ranged from –500 to +600 DALYs per 100,000 population across countries.

Fig. 6. Projected trends in ischemic stroke burden by sex.

Predicted trends for age-standardized incidence (a and b), prevalence (c and d), death rate (e and f), and DALYs (g and h) of ischemic stroke (IS) for males and females, based on the Autoregressive Integrated Moving Average (ARIMA) model (n = time series dataset). The shaded areas represent 2.5–97.5% uncertainty intervals of the predictions, with darker shading indicating central quantiles and lighter shading representing wider intervals. Data are generated from the GBD results tool (https://ghdx.healthdata.org/gbd-results-tool). ASPR Age-Standardized Prevalence Rate, DALYs Disability-Adjusted Life Years, IS Ischemic Stroke, ARIMA Autoregressive Integrated Moving Average. The source data for Fig. 6 are provided in Supplementary Data 14. Actual sizes: By 2036, projected incidence rates range from 200 to 350 per 100,000, prevalence from 1000 to 1500, death rates from 50 to 120, and DALY rates from 500 to 1000, depending on sex and region.