Trends in stroke mortality rates in low- and middle-income countries (2010–2025): an umbrella review

Background: Stroke remains a leading cause of mortality and disability worldwide, with low- and middle-income countries (LMICs) bearing a disproportionately high burden. Although global age-standardized stroke mortality rates (ASMRs) have declined, absolute stroke-related deaths in LMICs continue to rise due to demographic shifts, increasing metabolic risk factors, and inconsistent access to acute care. Methods: We conducted an umbrella review of systematic reviews and meta-analyses published between January 2010 and March 2025, assessing stroke mortality trends in LMICs. Databases searched included PubMed, Google Scholar, Cochrane Library, Scopus, and Web of Science, supplemented by hand-searching reference lists and Global Burden of Disease repositories. Eligible studies reported temporal trends in stroke mortality in LMIC populations. Results: Eleven systematic reviews covering 82 LMICs met the inclusion criteria. Between 2010 and 2019, ASMRs declined annually by 1.2%–3.1%, with projected declines of 1.0%–2.0% by 2025. Despite declining ASMRs, absolute stroke deaths rose from 4.8 million in 2010 to 5.6 million in 2019, with projections of 6.1 million by 2025. Substantial regional disparities were observed: Sub-Saharan Africa exhibited the slowest ASMR decline, whereas Latin America and upper-middle-income countries experienced the largest reductions. Major contributing factors included hypertension (accounting for 45%–55% of stroke deaths), increasing prevalence of diabetes and obesity, air pollution exposure (10%–15% of urban stroke deaths), and variable access to acute stroke care, particularly in rural areas. Conclusion: Although ASMRs in LMICs are declining, absolute stroke-related deaths continue to increase, driven by population growth and aging. These findings underscore the urgent need for strengthened prevention strategies, early detection, and equitable access to acute stroke care. Policy interventions should prioritize hypertension control, reduction of metabolic risk factors, and expansion of stroke treatment infrastructure to mitigate future mortality trends.