Global Burden and Projections of Stroke Related to High Fasting Plasma Glucose in Young Adults: A Comparative Analysis From 1990 to 2050

BACKGROUND: To characterize global trends in stroke and its subtypes attributable to high fasting plasma glucose (FPG) among young adults over the period 1990 to 2023 and to project these trends to 2050. METHODS: Using GBD (Global Burden of Disease) 2023 estimates, we quantified deaths, disability-adjusted life years (DALYs), and age-standardized rates of stroke, ischemic stroke (IS), and intracerebral hemorrhage (ICH) attributable to high FPG in adults aged 20 to 44 years, stratified by sex, age group, and sociodemographic index. A Bayesian age-period-cohort model was used to project trends to 2050. RESULTS: From 1990 to 2023, global stroke DALYs and deaths attributable to high FPG in young adults increased by 21.9% and 13.5%, while age-standardized DALYs and death rates declined. IS-attributable DALYs and deaths rose by 49% and 31%, versus 7.1% and 6.5% for ICH, with steeper declines in age-standardized ICH rates, indicating a shift from ICH to IS. High and high-middle-sociodemographic index regions showed marked declines in age-standardized rates, whereas middle-to-low-sociodemographic index regions had stable or rising rates and the largest proportional increases in death. By 2050, DALYs from high FPG-related stroke are projected to increase by 66.6% globally, with larger rises for IS than ICH (111.4% versus 40%). CONCLUSIONS: Among young adults, the absolute burden of high FPG-attributable stroke is growing, shifting toward IS and increasingly concentrated in women, adults aged 40 to 44 years, and lower-sociodemographic index regions, highlighting the need for earlier, targeted IS prevention in hyperglycemic young adults.