The latest Global Stroke Fact Sheet 1990-2023: Global Burden of Disease study

Background and rationale: Stroke remains a leading cause of death and long-term disability worldwide despite substantial reductions in age-standardised rates over recent decades. Updated and comprehensive assessments of global stroke burden are essential to inform prevention strategies, health-system planning, and policy responses, particularly in the context of widening inequities between regions and the emergence of new environmental and metabolic risk factors. Methods: This review summarises the most recent Global Burden of Disease (GBD) 1990–2023 estimates for stroke, drawing on data from the 2025 GBD cardiovascular disease publication and the Institute for Health Metrics and Evaluation visualisation tools. Stroke burden was assessed for ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage using standard GBD definitions. Estimates of incidence, prevalence, mortality, disability-adjusted life years (DALYs), and population-attributable fractions (PAFs) for 24 modifiable risk factors were analysed globally and across 21 GBD regions. Results: In 2023, stroke was the second leading cause of death and the third leading cause of death and disability combined worldwide. Globally, there were 13.2 million incident strokes, 104.8 million people living with stroke, and 6.8 million stroke-related deaths, accounting for 156.5 million DALYs. Although age-standardised incidence, mortality, and DALY rates declined substantially since 1990, the absolute numbers of stroke events, deaths, and DALYs increased markedly, driven by population growth and ageing. Over 80% of stroke deaths and DALYs occurred in low- and middle-income countries. Ischaemic stroke accounted for 63.9% of incident cases, while haemorrhagic strokes contributed disproportionately to mortality and disability. Overall, 83% of the global stroke burden was attributable to modifiable risk factors, with high systolic blood pressure the leading contributor. Notably, the contribution of high ambient temperature, obesity, and lead exposure increased substantially between 1990 and 2023. Conclusions: Stroke remains largely preventable, yet its global burden continues to rise in absolute terms, with pronounced regional disparities. Intensified, region-specific prevention strategies targeting dominant risk factors, alongside equitable access to acute care and rehabilitation, are urgently required to reduce avoidable stroke-related death and disability worldwide.