Ischemic stroke burden across the World Health Organization regions: Temporal dynamics, regional inequalities, and forecasting insights from the Global Burden of Disease 2021 data

Abstract: BACKGROUND: Ischemic stroke remains a leading cause of death and disability worldwide, with significant differences across the World Health Organization (WHO) regions. Understanding these disparities is crucial for targeted public health strategies. MATERIALS AND METHODS: Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed ischemic stroke burden across the WHO regions from 1990 to 2021. Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were assessed. Trends were assessed through joinpoint regression, with a maximum of five joinpoints. Future projections were generated using Autoregressive Integrated Moving Average ( P = 3, d = 1, and q = 1) model. RESULTS: In 2021, a significant variation in the burden of ischemic stroke was evident across different WHO regions. The Western Pacific region saw the most pronounced growth in total incident cases, with an increase of 161.79% (95% UI: 145.49–155.68). Meanwhile, the Southeast Asia region experienced the greatest escalation in DALYs, rising by 137.33% (95% UI: 111.78–165.59). The European region showed the greatest decline in age-standardized mortality (−58.45%, 95% UI: −60.13 to −56.79) and DALYs (−54.50%, 95% UI: −56.52 to −52.67). Gender disparities were evident, particularly in the African region, where females bore a disproportionately higher burden. Predictive modeling suggests a continued decline in stroke mortality and DALYs, but a rising incidence and prevalence in all regions by 2036. CONCLUSIONS: The ischemic stroke burden varies widely across the WHO regions due to factors like aging populations, shifting disease patterns, and healthcare capacity. These findings underscore the need for region-specific prevention and management strategies to reduce the global stroke burden.