Burden of stroke and its subtypes in young adults in Asia, 1990-2021: risk factors and future predictions

Stroke remains a major global public health challenge, with persistent disparities in its burden across countries, and an increasing burden among young adults aged 15-49 has emerged as a growing concern. However, comprehensive evaluations of stroke and its subtypes among young adults in Asia remain limited. This study utilizes data from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), covering the period from 1990 to 2021, to assess the burden of stroke in Asia and provide evidence-based policy and resource allocation. In this study, we extracted GBD 2021 data to estimate the absolute numbers and rates of prevalence, incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to stroke and its subtypes among young adults (15-49 years) in Asia from 1990 to 2021, with data stratified by year, age group, and sex. In addition, we analyzed major risk factors and projected future trends through 2050. Our analysis showed that in 2021, stroke accounted for 14.70 million (95% UI 13.39-16.01 million) DALYs and 1.14 million (95% UI 0.99-1.32 million) new cases in Asia, with a DALY rate of 620.24 (95% UI 564.66-675.12) per 100,000 and an incidence rate of 48.22 (95% UI 41.81-55.69) per 100,000. From 1990 to 2021, absolute numbers of prevalence, incidence, mortality, DALYs, YLLs, and YLDs increased by 43.56%, 44.82%, 10.68%, 11.02%, 7.64%, and 38.54%, respectively. Although the rates of prevalence and incidence showed slight increases of 0.07% and 0.96%, the rates of mortality, DALYs, YLLs, and YLDs decreased by 22.84%, 22.61%, 24.96%, and 3.42%, respectively. Among stroke subtypes, both ischemic stroke (IS) and intracerebral hemorrhage (ICH) showed increases in the absolute numbers across six metrics, with IS demonstrating more pronounced growth. Subarachnoid hemorrhage (SAH) showed increases in the incidence, prevalence, and YLDs, while its rates of mortality, DALYs, and YLLs declined. The rates of all six metrics decreased for ICH and SAH, whereas the rates of prevalence, incidence, and YLDs for IS increased, alongside reductions in the rates of mortality, DALYs, and YLLs. The absolute numbers and rates of all six metrics increased with age across both sexes, with males consistently showing higher absolute numbers and the highest burden observed in the 45-49 age group. Apart from the prevalence and YLD rates, males demonstrated higher incidence, mortality, DALYs, and YLL rates across all age groups, peaking at 45-49 years. Moreover, the leading contributors to stroke-related DALYs included high systolic blood pressure, smoking, and air pollution. From 2021 to 2050, the prevalence and incidence of stroke will continue to rise, while mortality and DALYs rates are expected to decline. Overall, from 1990 to 2021, the burden of stroke and its subtypes among young adults in Asia has increased significantly, with notable differences across age groups and sex, and with population growth and demographic changes, this burden is expected to further intensify in the future. Therefore, future research and public health policies should focus more on targeted interventions addressing the specific needs of young adults to effectively control and alleviate the burden of stroke.