Global Burden of Pediatric Stroke (1990–2023): A Shift From Mortality Toward Disability

BACKGROUND: Pediatric stroke is a significant cause of long-term disability worldwide, with outcomes influenced by age, stroke subtype, and access to care. Our objective was to define the global burden of pediatric stroke by its impact on mortality and disability. METHODS: The Global Burden of Disease study uses advanced statistical modeling to analyze health across locations, synthesizing data on mortality, morbidity, and risk factors. We examined 2023 data from the study to assess deaths, years of life lost, and years lived with disability during 3 eras (1990-2001, 2002-2013, and 2014-2023) across high-income and low- and middle-income countries. We stratified the analysis by sex, age group, and stroke subtype. We calculated the proportion of burden attributable to disability (years lived with disability/[years lived with disability+years of life lost]) to assess shifts from fatal to nonfatal disease over time. RESULTS: Between 1990 and 2023, global age-standardized pediatric stroke incidence declined only modestly, whereas age-standardized years of life lost rates declined significantly, indicating that the lower mortality burden reflected better survival rather than a large reduction in disease occurrence. Because years lived with disability rates remained comparatively stable as mortality declined, the proportion of disease burden attributable to disability rose from 14.6% (1990-2001) to 21.7% (2014-2023). This transition was uneven across settings: high-income countries achieved faster mortality declines and reached a higher disability share, whereas low- and middle-income countries retained a higher mortality burden, reflecting a dual burden of ongoing premature death and rising disability. These patterns were consistent across age and sex strata. CONCLUSIONS: These data indicate that pediatric stroke is undergoing an epidemiological transition from a mortality-dominant burden to one increasingly driven by disability, reflecting improved survival but with uneven distribution worldwide. Reducing the disability burden, through better stroke recognition education and expanded access to prevention, acute stroke care systems, reperfusion, and rehabilitation, particularly in low- and middle-income countries, should be prioritized alongside efforts to close persistent global inequities in outcomes.