Global trend and disparity in the burden of ischemic stroke attributable to high body-mass index from 1990 to 2021 and projection to 2050: a systematic analysis based on the Global Burden of Disease Study 2021

Background Obesity and overweight are increasingly recognized as significant risk factors for the incidence and progression of ischemic stroke (IS). However, its epidemiological investigation including the disease burden and its trends remains insufficiently explored. This research aimed to reveal and predict the disease burden of ischemic stroke attributable to high body-mass index (IS-HBMI), which would offer significant references for focused prevention and disease management methods.

The study extracted data from the Global Burden of Disease Study 2021 (GBD 2021). Death cases, disability-adjusted life years (DALYs) case, age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were obtained from GBD 2021 to assess the global burden from 1990 to 2021. Decomposition analysis explored the driving factors to IS-HBMI. The Average Annual Percent Change (AAPC) in ASMR and ASDR of IS-HBMI was determined to analyze temporal trends by Joinpoint regression analysis. Bayesian age-period-cohort (BAPC) modelling was used to predict the burden of disease up to 2050.

The global deaths and DALYs of IS-HBMI were 4439186 and 51520000 in 2021, exhibiting a continuous growth trend over the past 32 years. The ASMR and ASDR for males showed faster growth. The disease burden was greatest among middle-aged and older populations, while the rapidly increase in adolescents should not be overlooked. High sociodemographic index (SDI) regions and Latin America each recorded the highest disease burden within their respective categories of SDI regions and GBD regions. Additionally, Predictive models indicated a gradual upward trend from 2022 to 2049.

The study revealed that the global disease burden of IS-HBMI had continuously increased from 1990 to 2021, and it was predicted to escalate until 2050. The findings emphasize the need for more detailed IS screening and weight loss measures tailored to specific regions and populations, which would benefit efforts to curb the projected rise in IS-HBMI deaths. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by National Natural Science Foundation of China: 82301543. and Joint Funds for the Innovation of Science and Technology,Fujian Province: 2024Y9123, Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study involved analysis of existing, de-identified, aggregated data from the Global Burden of Disease (GBD) study, which is publicly available. Therefore, it was considered exempt from review by the Fujian medical university Institutional Review Board (IRB) or Ethics Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes