(C-008) Regional and Socioeconomic Disparities in the Lifetime Risks of Stroke and Its Risk Factors: A Comprehensive Analysis from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Stroke is the third leading cause of death and the fourth leading cause of disability-adjusted life-years globally in 2021, imposing a substantial health and socioeconomic burden. However, limited studies have analyzed the stroke burden from the perspective of the lifetime risk (LR).

Objectives: To estimate the LR of developing and dying from stroke and its subtypes and to investigate regional and socioeconomic disparities.

Methods:

Design: Population based study.
Setting: Population from 204 countries and territories, 1990 to 2021.
Exposures or interventions: Stroke (including ischemic stroke [IS], intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) and its risk factors.
Main outcome measures: Lifetime risk and average annual percentage change (AAPC).
Statistical analysis: The LR and its 95% confidence interval (CI) were estimated using the adjusted for multiple primaries methods accounting for demographic changes and competing risks from causes of death.

Results: In 2021, the LRs of stroke development and mortality were 16.24% (95% CI: 16.23%–16.25%) and 11.93% (95% CI: 11.92%–11.94%), respectively. Although the LR of stroke declined globally from 1990 to 2021, substantial regional disparities persisted. In East Asia, the lifetime of developing (AAPC: 2.25, 95% CI: 2.08–2.42) and dying (AAPC: 1.58, 95% CI: 1.47–1.69) from IS significantly increased. Additionally, the LR of stroke and its subtypes remains high in other regions of Asia, and in Eastern and Central Europe. In contrast, the stroke burden has continued to decrease in Africa and the Americas. At the national level, China, North Korea, Solomon Islands, and Vietnam had particularly high disease burdens and these countries were also identified by frontier analysis as having the greatest potential for stroke prevention and control. The concentration index revealed that from 1990 to 2021, the LRs of developing and dying from IS and SAH remained concentrated in countries with higher Socio-demographic Index (SDI), although the disparities in LRs narrowed. In contrast, the LRs of ICH remained concentrated in countries with lower SDI, and the disparities further intensified. High systolic blood pressure was the leading cause of lifetime mortality risk globally. In higher SDI regions, high HDL cholesterol and fasting glucose contributed to higher lifetime risks of dying from stroke. In contrast, in lower SDI regions, household air pollution from solid fuels and lead exposure were the main contributors.

Conclusions: In 2021, the LRs of stroke development and mortality were approximately 16% and 12%, respectively. The LRs of stroke exhibited significant socioeconomic and regional disparities, highlighting the need for interventions targeting the major contributing factors.