Global and regional burden of ischemic stroke disease from 1990 to 2021: an age-period cohort analysis

Abstract Background Ischemic stroke is a major global public health concern. This study evaluates the burden of ischemic stroke in 2021, analyzes trends since 1990, and predicts future burdens. Methods Data were sourced from the Global Burden of Disease Study 2021, focusing on incidence, mortality, and disability-adjusted life years (DALYs) on a global, regional, and all socio-demographic index area (SDI) basis. Joinpoint regression and age-period-cohort modeling were employed for trend analysis. Results In 2021, there were 7,804,449 (95% UI, 6,719,760 - 8,943,692) global ischemic stroke patients, resulting in 3,591,499 (95% UI, 3,213,281 - 3,888,327) deaths and 70,357,912 (95% UI, 64,329,576 - 76,007,063) DALYs. East Asia had the highest number of cases, while Eastern Europe had the highest age-standardized incidence rate. High-income countries reported the lowest rates of incidence, mortality, and DALYs, which are significantly declining overall. From 1990 to 2021, the age-standardized incidence rate decreased by -0.578% annually, mortality by -0.927%, and DALYs by -14.372%. The rates are influenced by age, time, and cohorts, generally increasing with age but declining over time, especially in high SDI regions. Key risk factors include hypertension, environmental pollution, and high low density lipoprotein cholesterol, with hypertension having the most significant and stable impact. Projections for 2035 suggest worsening ischemic stroke outcomes for those over 45, while improvements are expected for individuals under 35. The 50-59 age group’s age-standardized incidence rate may rise, but mortality and DALYs rates are expected to decline across all ages. Conclusion Our study shows a decline in ischemic stroke mortality and incidence, yet its global burden is rising due to aging populations and persistent health issues. This highlights the importance of targeting prevention and treatment, particularly for those over 45. Future efforts must tackle high rates in affected areas and address key risks like hypertension and high cholesterol.