Spatiotemporal patterns and future trends of global ischemic stroke burden

Background: Ischemic stroke remains a leading cause of morbidity and mortality worldwide, with substantial heterogeneity across regions, sexes, age groups, and levels of socioeconomic development. Previous studies have described global trends; however, integrated analyses combining long-term spatiotemporal patterns, sociodemographic stratification, and future projections remain limited. Methods: Data on ischemic stroke from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database, covering 204 countries and territories. Age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs) were analyzed by age, sex, region, and sociodemographic index (SDI). Temporal trends were assessed using estimated annual percentage change (EAPC). Future disease burden from 2022 to 2041 was projected using autoregressive integrated moving average (ARIMA) models implemented with the R package forecast (version 8.24.0). Results: Globally, from 1990 to 2021, age-standardized incidence declined from 109.79 to 92.39 per 100,000 (EAPC = -0.67), mortality from 73.15 to 44.18 per 100,000 (EAPC = -1.83), and DALYs from 1286.31 to 837.36 per 100,000 (EAPC = -1.59), whereas prevalence showed only a modest decrease (EAPC = -0.18). Marked disparities were observed across SDI levels: middle SDI regions experienced increasing prevalence (EAPC = 0.27) and incidence (EAPC = 0.12), while high SDI regions demonstrated the most pronounced reductions in mortality and DALYs. Eastern Europe, East Asia, and Southern Sub-Saharan Africa remained high-burden regions. Pronounced sex- and age-specific patterns were identified, with men exhibiting earlier peak incidence (65-79 years) and women showing later and shifting peak prevalence toward older age groups. Projections indicate that by 2041, global age-standardized prevalence will increase by approximately 15.3%, driven primarily by a substantial rise among females (from 769.40 to 1005.77 per 100,000), despite continued declines in mortality and DALYs. Conclusion: This comprehensive spatiotemporal analysis reveals a paradoxical pattern of increasing ischemic stroke prevalence amid declining mortality and disability, with widening sex- and SDI-related disparities. By integrating long-term trends with sex-specific future projections, this study provides novel evidence to inform targeted prevention strategies, gender-sensitive interventions, and context-specific health policy planning to mitigate the evolving global burden of ischemic stroke.