Global Trends, Inequities, and Emerging Risks of Early-Onset Ischemic Stroke.

INTRODUCTION: We aimed to evaluate the global burden, spatial disparities, and risk factors of early-onset ischemic stroke (EOIS). METHODS: Using data from the Global Burden of Disease Study 2021, we estimated incidence, mortality, and DALYs. Health inequality was measured with Slope Index of Inequality (SII) and Concentration Index (CII). Frontier analysis assessed national efficiency. Age-period-cohort and decomposition models analyzed trends and drivers. RESULTS: Between 1990 and 2021, global age-standardized incidence, mortality, and DALYs for EOIS declined, but absolute cases rose due to population growth and aging. Males and populations in Central Asia and Eastern Europe had the highest burden. East Asia saw rising age-standardized incidence. Health inequalities widened globally, with countries like Nauru and Kiribati showing the largest gaps. High-SDI countries such as Lithuania and the U.S. demonstrated unmet healthcare efficiency. Incidence and mortality increased with age, especially in men over 35. Population aging and growth were key drivers. Leading risk factors included high LDL and hypertension, while high BMI, high ambient temperature, and sugar-sweetened beverages emerged as growing risks. Low whole grain intake was a major dietary risk. CONCLUSIONS: The absolute burden of EOIS has increased due to demographic shifts. Significant socio-demographic and regional disparities persist, with men and certain regions facing disproportionately high risks. Metabolic risks remain central, while emerging factors are gaining importance.