Abstract Background and aims Ischemic stroke is a leading cause of mortality and long-term disability worldwide. Environmental factors, such as those in the Aral ecological crisis region, may contribute to increased stroke risk and worse outcomes. This study aimed to evaluate the epidemiological characteristics, age distribution, gender prevalence, and mortality of ischemic stroke patients living in this region between 2020 and 2023. Methods We conducted a retrospective analysis of ischemic stroke cases in the Aral ecological crisis region from 2020–2023. Demographics, newly diagnosed cases, rural versus urban residence, and mortality were recorded to evaluate trends in incidence, age distribution, and outcomes. Results Between 2020 and 2023, a total of 505, 431, and 651 ischemic stroke cases were registered, respectively. In 2020, patients aged ≥65 years accounted for 163 cases, with 264 women and 355 rural residents; newly diagnosed cases numbered 370, and 57 deaths were recorded. In 2022, 170 patients were aged ≥65 years, with 173 women and 237 rural residents; newly diagnosed cases were 372, and 79 deaths occurred. In 2023, 272 patients were aged ≥65 years, with 282 women and 403 rural residents; newly diagnosed cases decreased to 310, while 72 deaths were reported. Trends indicate a progressive increase in total stroke cases, particularly among elderly and rural populations, while mortality remained consistently high. Conclusions Ischemic stroke incidence in the Aral ecological crisis region increased from 2020–2023, particularly among elderly and rural populations. Mortality remained high, highlighting the need for targeted prevention, early detection, and improved stroke care. Conflict of interest
Nursulu Dosbergenova (2026) studied this question.