Key result
Young-adult incident stroke in LMICs increased ~63% from 1990 to 2023 despite falling mortality.
Why the study?
Stroke in young adults aged 15-49 years is a major public health problem in low- and middle-income countries, but subtype-specific analyses and long-term projections using the latest GBD estimates remain limited.
Observational
Yes
Despite declining stroke death and DALY rates among young adults in LMICs, absolute incidence and prevalence are rising, underscoring the need for early-life vascular risk control, particularly for ischemic stroke.
Rising stroke burden in LMIC young adults may warrant enhanced prevention efforts; leaves open drivers of rising incidence amid falling mortality.
BACKGROUND: Stroke in young adults (15-49 years) is a major public health problem in LMICs, but subtype-specific analyses and long-term projections using the latest GBD estimates remain limited. METHODS: Using GBD 2023 estimates, we assessed incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for stroke and its subtypes across 129 LMICs from 1990 to 2023. Temporal trends, age- and sex-specific patterns, economic and geographic variations, health inequality, and drivers of change were evaluated. ARIMA models were used to generate trend-based projections for 2024-2045. RESULTS: From 1990 to 2023, incident and prevalent stroke cases among young adults in LMICs increased by 63% and 60%, respectively, whereas death and DALY rates declined (estimated annual percentage change [EAPC]: -0.93% and -0.92%). Intracerebral hemorrhage (ICH) remained the leading contributor to deaths and DALYs in 2023, while ischemic stroke (IS) accounted for the largest number of prevalent cases, and only IS showed increasing incidence and prevalence rates. Males generally had higher rates, with the disparity becoming more pronounced with age. Population growth was the principal driver of the rising absolute burden in low- and lower-middle-income countries, while favorable epidemiological change offset demographic pressure in upper-middle-income countries. By 2045, death and DALY rates were projected to decline further, but IS incidence and prevalence were projected to remain on an upward trend. CONCLUSION: Among young adults in LMICs, the absolute numbers of incident and prevalent stroke cases increased despite declining death and DALY rates. Prevention strategies should prioritize early-life vascular risk control, particularly for IS.
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Gao et al. (2026) conducted an observational in Stroke. Time period (1990 to 2023) was evaluated on Incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for stroke (63% increase in incidence, 60% increase in prevalence). From 1990 to 2023, incident and prevalent stroke cases among young adults in LMICs increased by 63% and 60%, respectively, despite declining death and DALY rates.
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