Global, regional, and national burden of tobacco-attributable stroke (1990-2021) with projections to 2030: Systematic analysis of the 2021 Global Burden of Disease study

A BSTRACT Objective: This study aims to measure the global, regional, and national burden of tobacco-attributable stroke based on the 2021 Global Burden of Disease (GBD) study and project future trends up to 2030. Methods: The 2021 GBD study was utilized to assess the global, regional, and national deaths and disability-adjusted life years (DALYs) of tobacco-attributable stroke. Measures were stratified by sex, region, country, age, and sociodemographic index (SDI). Global burden was projected to 2030 using autoregressive integrated moving average models. Results: In 2021, tobacco-attributable stroke caused 1,077,805 (95% uncertainty interval(UI): 865,541-1,320,754)deaths and 28,531,039 (95% UI: 23,461,345-34,072,552) DALYs globally. Its age-standardized death (12.65, 95% UI: 10.09-15.55) and DALYs (328.94, 95% UI: 270.32-393.11) rates per 100,000 population were 46.35% and 46.36% lower than 1990 levels, respectively. East Asia (25.2/100,000) and Southeast Asia (638.38/100,000) had the highest regional death and DALYs rates, while Kiribati recorded the highest national rates (48.17, 95% UI: 35.73-62.23; 1467.67, 95% UI: 1,108.11-1,894.48/100,000). The 90-94 age group had the highest death rate (402.92, 95% UI: 272.51-550.16/100,000) and the 85-89 group the highest DALYs rate (2,075.00, 95% UI: 1,411.86-2,831.91/100,000). Middle SDI regions bore heavy burdens; 2030 projections show 24.44% and 24.25% reductions in age-standardized death and DALYs rates, respectively. Conclusion: Despite declining deaths and DALYs, the increasing absolute injury burden necessitates intensified prevention efforts. Targeted interventions are crucial to address persistent geographic, demographic (especially males), and socioeconomic (low SDI regions) disparities.