Spatiotemporal Distributions and Forecasts of Working-Age Stroke Across 953 Locations, 1980 to 2040

BACKGROUND: The working-age population (15-64 years) is the primary contributor of stroke-related income losses projected for 2020 to 2050. However, a comprehensive profile of current and forecasted working-age stroke burden from global to subnational levels remains unavailable. METHODS: Stroke prevalence, deaths, and disability-adjusted life-years (DALYs) in the working-age population were estimated for the observational period (1980-2021) using standardized methods from the GBD study (Global Burden of Disease) and forecasted for 2022 to 2040 with a modified Transformer model. RESULTS: During the observation period, global stroke prevalence in the working-age population remained relatively stable, while death and DALY rates showed a consistent decline. However, the Philippines experienced nationwide increases, with 91.5%, 26.8%, and 39.0% of provinces showing rising prevalence, DALY, and death rates, respectively. Subtype rises coexisted with overall declines in specific locations. In 2021, more than half of low- to high-middle sociodemographic index (SDI) countries ranked among the top 100 for prevalence, whereas low-SDI countries had the highest proportional representation in the top 100 for deaths (73.5%) and DALYs (76.5%). Cross-national inequality analyses indicated that prevalence was increasingly concentrated in higher-SDI countries, whereas DALY and death burdens were disproportionately concentrated in lower-SDI countries. Frontier analysis revealed that by 2021, over 90% of countries failed to achieve optimal working-age stroke burden levels. Projections to 2040 suggest stable global prevalence and continued declines in DALY and death rates. However, against the global trend, rising rates are projected for prevalence in 12.8% of countries, for DALYs in 12.3%, and for deaths in 16.3%, with these increases primarily concentrated in low- to high-middle-SDI regions. CONCLUSIONS: Globally, stroke prevalence rates stagnated in the working-age population, while DALY and death rates declined during the observation period; both patterns are expected to persist through 2040. However, local divergences and subtype paradoxes persist. Policies must be context-specific across prevention, acute care, and rehabilitation.