G20 stroke burden 1990-2035: trends, projections and precision health insights

Stroke persists as the second leading global cause of mortality and disability. We analyzed G20 nations using Global Burden of Disease (GBD) 2021 data (1990-2021) to provide a new perspective.

We obtained age-standardized rates (ASR) of stroke mortality, incidence, prevalence, and YLLs (years of life lost) across G20 nations. Attributable risks identified key factors, decomposition analysis explored epidemiological drivers, and inequality analysis assessed socioeconomic disparities. Bayesian age-period-cohort (BAPC) modeling projected trends to 2035.

In 2021, stroke was the second leading cause of level 3 mortality in the G20 countries, accounting for 11.83% (95% UI:10.75-12.59) of total deaths, and the leading cause of level 3 mortality in China and Indonesia. In 2021, stroke caused 5.27 million (4.67-5.78) deaths in the G20 countries, with 8.74 million (7.80-9.77) new cases and 67.82 million (63.67-72.51) prevalent cases, the years of life lost (YLLs) totaled 100.63 million (91.46-110.31). China had the highest absolute burden; Indonesia showed the highest ASMR (Age-standardized mortality rates), ASIR (Age-standardized incidence rates), ASPR (age-standardized prevalence rates), and ASYR (age-standardized years of life lost), South Korea had the steepest ASR declines. High systolic blood pressure and air pollution were primary risk factors. Projections reveal Indonesia's rapid ASR declines contrasting with China's rising prevalence among adults ≥ 75 years and growing case numbers in aging populations.

While stroke ASR decreased significantly since 1990, substantial cross-country disparities persist, linked to socioeconomic development. Absolute burden will increase with aging populations, necessitating targeted interventions against hypertension, air pollution, and elderly healthcare gaps.