Stroke burden and risk factor disparities across East Asia, Western Europe, and North America, 1990-2023, with forecasts to 2050

BACKGROUND: Stroke is the second leading cause of death and major cause of disability worldwide. Substantial regional variations exist in modifiable risk factor profiles, indicating the need for region-specific prevention strategies. Using the Global Burden of Disease (GBD) 2023 data, the burden, risk factor contributions, and future projections of stroke were compared across East Asia, Western Europe, and North America from 1990 to 2023, with forecasts to 2050. METHODS: Deaths, disability-adjusted life years (DALYs), incidence, and prevalence of total stroke and the three subtypes were analyzed across 204 countries using GBD 2023 estimates. Temporal trends were assessed using estimated annual percentage changes. Changes in mortality were decomposed into population growth, population aging, and epidemiological components. Risk factor attribution was conducted within the GBD comparative risk assessment framework. The future burden through 2050 was projected using Bayesian age-period-cohort models with integrated nested Laplace approximation, incorporating intervention scenarios targeting systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, and ambient particulate matter (PM2.5). RESULTS: From 1990 to 2023, the global age-standardized stroke mortality rate declined by 51.7%, whereas the absolute deaths increased from 4.58 million to 6.55 million. A seven-fold disparity was observed across the socio-demographic index strata. High SBP was the leading risk factor globally, while the second-ranking factor differed: ambient PM2.5 in East Asia and high LDL cholesterol in Western Europe and North America. Population aging accounted for a 113.1% increase in stroke deaths in East Asia, whereas adverse epidemiological trends have contributed to increased mortality in North America. A 50% reduction in high SBP prevalence is projected to avert substantial stroke deaths annually by 2050. CONCLUSIONS: Population aging is expected to continue to increase the absolute stroke burden despite declining age-standardized rates. Regional heterogeneity in the risk factor profiles supports differentiated prevention strategies that combine hypertension control with targeted environmental or metabolic interventions.