Temporal Trends and Burden of Stroke in Saudi Arabia: A Secondary Analysis of Global Burden of Disease Data from 1990 to 2021

Abstract Background and Objectives: Stroke remains a leading global cause of mortality and disability, yet comprehensive epidemiological analyses specific to Saudi Arabia are limited. This study analyzed temporal trends in stroke incidence, mortality, and disability-adjusted life years (DALYs) using Global Burden of Disease (GBD) 2021 estimates for Saudi Arabia from 1990 to 2021, extending previous analyses through 2 additional years of data. We examined subtype distributions, risk factor attributions, and compared findings against regional and international benchmarks. Methods: We conducted a secondary analysis of GBD 2021 data. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and DALY rates were extracted for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. We utilized Joinpoint regression to calculate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Poisson regression examined sex differences. We supplemented GBD-modeled estimates with descriptive synthesis of published hospital registry data and systematic review findings to provide clinical context, clearly distinguishing between GBD estimates and empirical data sources throughout. Results: Based on GBD 2021 estimates, ASIR in Saudi Arabia showed variable trends by stroke subtype from 1990 to 2021. Age-standardized DALY rates demonstrated significant decline with AAPC of -0.85 (95% CI: -0.88 to -0.83) for smoking-attributable burden. By 2021, total stroke deaths reached 1,408 annually despite declining ASMR. GBD comparative risk assessment identified high fasting plasma glucose as contributing 6.89% of stroke DALYs nationally, the highest proportion globally. Hospital-based studies in Saudi Arabia reported mean age at first stroke of 63 years, notably younger than Western populations, though these empirical data are distinct from GBD modeled estimates. Ischemic stroke predominated at 69%–87% across clinical case series. Conclusions: Despite declining ASMR and DALY trends in GBD estimates, Saudi Arabia faces substantial stroke burden marked by high metabolic risk factor attribution and younger onset ages in clinical populations. Meeting Vision 2030 health targets requires accelerated primary prevention for metabolic risks and expanded acute stroke treatment capacity nationwide.