Global, Regional, and National Burden of Ischemic Stroke, 1990–2019

BACKGROUND AND OBJECTIVES: To the best of our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. Thus, our objective was to examine ischemic stroke burden at the global, regional, and national levels in terms of sex, age, and social development index (SDI). METHODS: Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and disability-adjusted life-years (DALY) trends of ischemic stroke. Measures were stratified by sex, region, country, age, and SDI. RESULTS: The global age-standardized incidence rate (ASIR) of ischemic stroke decreased from 1990 to 2019, with an EAPC of -0.43 (95% confidence interval [CI] -0.54 to -0.32). High-middle and middle SDI regions had much higher ASIR, age-standardized death rate (ASDR), and age-standardized DALY rates due to ischemic stroke than other SDI regions. Regionally, East Asia had the highest ASIR of ischemic stroke in 2019 and the largest increase in the ASIR from 1990 to 2019. Nationally, Egypt (EAPC 1.40, 95% CI 1.27-1.52) and China (EAPC 1.10, 95% CI 1.00-1.20) had the most pronounced increases in the ASIR of ischemic stroke. Globally, there was an increase in ischemic stroke incidence with increasing age, especially in women 50 to 69 years of age or older. The global ASDR decreased from 1990 to 2019, with an EAPC of -1.63 (95% CI -1.72 to -1.53). The ASDR and age-standardized DALY rates increased most in southern sub-Saharan Africa, eastern sub-Saharan Africa, and southeast Asia. DISCUSSION: The ASIR, ASDR, and age-standardized DALY rates remained high in high-middle and middle SDI regions. East Asia, southern sub-Saharan Africa, eastern sub-Saharan Africa, and Southeast Asia had the greatest burden of ischemic stroke.