Global and regional burden of ischemic stroke disease from 1990 to 2021: an age-period-cohort analysis

Abstract Ischemic stroke is a significant global public health issue that impacts health burdens across various regions. This study analyzed data from the Global Burden of Disease Study 2021 to assess the incidence, mortality, and Disability-Adjusted Life Years (DALYs) associated with IS worldwide and across different Socio-Demographic Index (SDI) regions. Using Joinpoint regression and Age-Period-Cohort (APC) models, we examined trends in disease burden and made projections for 2022 to 2035. As of 2021, approximately 7,804,449 (95% UI, 6,719,760–8,943,692) individuals were affected by ischemic stroke, resulting in 3,591,499 (95% UI, 3,213,281–3,888,327) deaths and 70,357,912 (95% UI, 64,329,576 − 76,007,063) DALYs. These numbers represent increases of 88.0%, 55.0%, and 52.4% since 1990. Despite these increases, age-standardized incidence, mortality, and DALYs rates are declining, with annual percentage change rates (AAPC) of -0.578%, -0.927%, and − 14.372%, consistent across all SDI regions. The global rates of IS are influenced by age, period, and cohort, showing increased rates with age but declining over time, particularly in high SDI regions. Major risk factors include hypertension, environmental pollution, and low-density lipoprotein cholesterol (LDL-C). Projections indicate that by 2035, incidence, mortality, and DALYs will rise among those aged 45 and above, while decreasing for those under 35. This highlights the urgent need for preventive and therapeutic strategies targeting ischemic stroke, particularly for individuals over 45, while addressing the impact of major risk factors in high-burden regions.