Epidemiology of stroke in India: A systematic review of incidence and risk factors

Background: Stroke is a leading cause of mortality and long-term disability in India. Rapid demographic transition, urbanization, population ageing, and increasing prevalence of non-communicable diseases have significantly increased the burden of stroke. Despite several regional epidemiological studies, comprehensive evidence regarding stroke incidence and associated risk factors remains limited. Objective: To systematically review published literature on the incidence and major risk factors of stroke among the Indian population. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, Web of Science, Embase, CINAHL, and Google Scholar were searched for studies published between January 2000 and December 2025. Population-based cohort studies, registries, and observational studies reporting stroke incidence and/or risk factors in India were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale. Results: Twenty-four studies fulfilled the eligibility criteria. Reported annual stroke incidence ranged from 108 to 172 cases per 100,000 population, with higher rates observed in urban and elderly populations. The most frequently reported risk factors were hypertension (55–80%), diabetes mellitus (20–40%), tobacco use (25–45%), dyslipidaemia (20–35%), obesity (15–30%), atrial fibrillation, excessive alcohol intake, physical inactivity, and previous cardiovascular disease. Advancing age and male gender were consistently associated with increased stroke incidence. Rural populations demonstrated delayed diagnosis and poorer access to specialized stroke care. Conclusion: Stroke incidence in India continues to increase due to the growing prevalence of modifiable cardiovascular risk factors. Early detection of hypertension and diabetes, smoking cessation, healthy lifestyle promotion, and improved access to acute stroke services are essential to reduce the national burden of stroke. Future nationwide longitudinal studies are required to generate representative epidemiological data.