Global, regional, and national burden of ischemic stroke attributable to active smoking, 1990-2021

Ischemic stroke is a major global health issue, with active smoking identified as a key modifiable risk factor. This study examines the burden of ischemic stroke due to active smoking from 1990 to 2021, across different sociodemographic contexts.

Data from the Global Burden of Disease (GBD) 2021 database were used to extract information on mortality and disability-adjusted life years (DALYs) attributable to active smoking-related ischemic stroke. Countries and regions were categorized by the sociodemographic index (SDI) into five levels. Statistical analyses were conducted using R Studio, including the calculation of estimated annual percentage change (EAPC) and joinpoint regression models.

In 2021, there were 342674 deaths globally due to ischemic stroke caused by active smoking, with an age-standardized mortality rate (ASMR) of 4.06 and a population-attributable fraction (PAF) of 9.54%. The number of deaths increased by 35.59% from 1990 to 2021, with males aged ≥70 years experiencing the largest increase. The global age-standardized DALY rate in 2021 was 98.29, with an overall increase in DALYs by 33.55% from 1990. Regional analysis revealed significant disparities, with the middle SDI region reporting the highest number of deaths and DALYs, while the high SDI region reported the lowest. Geographically, East Asia had the highest burden in 2021. Nationally, China had the highest number of deaths and DALYs due to smoking-related ischemic stroke.

This study highlights the significant global burden of ischemic stroke attributable to active smoking and the critical need for targeted smoking cessation programs and stroke prevention strategies. Despite overall declines in ASMR and age-standardized DALY rates, the burden varies significantly across different regions and sociodemographic groups. Effective public health interventions, particularly in low- to middle-SDI regions, are essential to mitigate the impact of smoking-related ischemic stroke and improve global health outcomes.