The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND: We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted. RESULTS: From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people. CONCLUSIONS: Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.