Global and regional burden of ischemic stroke attributable to smoking and high alcohol use from 1990 to 2021, with projections to 2050

OBJECTIVE: This study employs data from the Global Burden of Disease Study (GBD) 2021 to analyze the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of ischemic stroke (IS) attributable to smoking and high alcohol use from 1990 to 2021 across 204 countries and territories, stratified by Socio-demographic Index (SDI), region, sex, and age. Trends are assessed using estimated annual percentage change (EAPC), and future burdens are projected to 2050 using an autoregressive integrated moving average (ARIMA) model. RESULTS: Globally, the burden of IS attributable to both risk factors declined, with smoking consistently associated with higher ASMR and ASDR than high alcohol use. High-SDI regions showed the most substantial reductions, whereas low-SDI regions experienced stagnant or slightly increasing burdens. Southeast Asia was the only region with a rising trend in smoking-related IS, while Tropical Latin America achieved remarkable success in alcohol control. The burden was higher among males and older age groups for smoking, and more prominent in young and middle-aged adults for alcohol use. Projections suggested a continuing decline in high-SDI regions but limited improvement in low-SDI areas by 2050. CONCLUSION: Significant geographic and demographic disparities persist in the IS burden attributable to smoking and high alcohol use. Targeted policy interventions-especially enhanced tobacco and alcohol control in low- and middle-SDI regions, along with focused strategies for males and high-risk age groups-are urgently needed to reduce the global burden of ischemic stroke.