Burden of Stroke Among Young Adults in Low- and Middle-Income Countries, 1990–2023, and Projections to 2045: An Analysis of Global Burden of Disease Study 2023 Data

BACKGROUND: Stroke in young adults (15-49 years) is a major public health problem in LMICs, but subtype-specific analyses and long-term projections using the latest GBD estimates remain limited. METHODS: Using GBD 2023 estimates, we assessed incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for stroke and its subtypes across 129 LMICs from 1990 to 2023. Temporal trends, age- and sex-specific patterns, economic and geographic variations, health inequality, and drivers of change were evaluated. ARIMA models were used to generate trend-based projections for 2024-2045. RESULTS: From 1990 to 2023, incident and prevalent stroke cases among young adults in LMICs increased by 63% and 60%, respectively, whereas death and DALY rates declined (estimated annual percentage change [EAPC]: -0.93% and -0.92%). Intracerebral hemorrhage (ICH) remained the leading contributor to deaths and DALYs in 2023, while ischemic stroke (IS) accounted for the largest number of prevalent cases, and only IS showed increasing incidence and prevalence rates. Males generally had higher rates, with the disparity becoming more pronounced with age. Population growth was the principal driver of the rising absolute burden in low- and lower-middle-income countries, while favorable epidemiological change offset demographic pressure in upper-middle-income countries. By 2045, death and DALY rates were projected to decline further, but IS incidence and prevalence were projected to remain on an upward trend. CONCLUSION: Among young adults in LMICs, the absolute numbers of incident and prevalent stroke cases increased despite declining death and DALY rates. Prevention strategies should prioritize early-life vascular risk control, particularly for IS.