Burden of stroke attributable to environmental, behavioral, and metabolic risk factors in Eastern Sub-Saharan Africa, from 1990 to 2023

Introduction Stroke is the second leading cause of death and disability worldwide, particularly affecting individuals aged 55 years and older. The Eastern Sub-Saharan Africa (ESSA) region faces a rising burden. However, comprehensive data on the role of environmental, behavioral, and metabolic risk factors are limited in low-resource settings. Methods This study utilized Global Burden of Diseases 2023 estimates and methods. Results In 2023, stroke attributable to all risk factors accounted for 110,013 deaths (rate: 359 per 100,000 population; 95% UI: 275–449) and 2,359,559 DALYs (rate: 7,702 per 100,000 population; 95% UI: 6,043–9,495). Metabolic risk factors contributed the largest burden (6,286 DALYs per 100,000 population; 95% UI: 4,573–8,279), followed by environmental (4,146; 95% UI: 2,621–5,668) and behavioral (2,505; 95% UI: 1,342–3,956) risks. Among individual risk factors, high systolic blood pressure was the leading contributor, followed by dietary risks, household air pollution, and high LDL cholesterol. Zambia had the highest DALYs rate (12,418 per 100,000 population; 95% UI: 9,658–15,576), while Comoros had the lowest (4,063; 95% UI: 2,969–5,120). No significant annualized reductions were estimated across risk factor categories from 1990 to 2023, and trends remained stable. Significant age-related differences were noted between ischemic stroke and subarachnoid hemorrhage. Conclusion The stroke burden in the ESSA region has not significantly declined over the past three decades, persisting as a major public health crisis. Targeted interventions focusing on hypertension control, dietary modification, and clean energy transitions are urgently needed to reduce this burden.