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ORIGINAL RESEARCH ARTICLE

Global burden of ischemic stroke and attributable risk factors from 1990 to 2021: Insights from the Global Burden of Disease study

Xi Peng1 ,  Le Li1 ,  Sheng Su1 ,  Zhenhao Zhang1 ,  Yulong Xiong1 ,  Likun Zhou1 ,  Jing Luo1 ,  Shengsong Zhu1 ,  Zhuxin Zhang1 ,  Lihui Zheng1* ,  Yan Yao1*
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1 Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
Brain & Heart, 025420063 https://doi.org/10.36922/BH025420063
Received: 19 October 2025 | Revised: 17 December 2025 | Accepted: 24 December 2025 | Published online: 22 January 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Ischemic stroke remains a major contributor to population-level health loss, yet contemporary patterns vary widely across locations and over time. Hence, evidence integrating mortality and disability, and benchmarking prevention potential, is still needed. We characterized the ischemic stroke burden using the Global Burden of Disease 2021 estimates for 1990–2021, reporting prevalence, incidence, and disability-adjusted life years (DALYs) per 100,000 persons. The share of DALYs associated with individual risk factors was derived as population-attributable fractions. For 2021, per 100,000 persons, the global age-standardized prevalence, incidence, and DALY rates for ischemic stroke were 819.5 (95% uncertainty interval [UI]: 760.3–878.7), 92.4 (95% UI: 79.8–105.8), and 837.4 (95% UI: 763.7–905.0). From 1990 to 2021, the prevalence decreased by 3.5% (95% UI: −5.1% to −2.1%), incidence decreased by 15.8% (95% UI: −18.8% to −13.3%), and DALYs decreased by 34.9% (95% UI: −39.5% to −30.0%). Patterns differed substantially across sexes, sociodemographic index (SDI), and geographies. DALY rate attribution was dominated by systolic blood pressure (58.38%), followed by low-density lipoprotein cholesterol (29.82%) and fasting plasma glucose (17.58%). Ischemic stroke incidence shifted from high-SDI regions to middle- and low-SDI regions from 1990 to 2021. Despite declining age-standardized rates, absolute numbers increased due to population growth, aging, and improved screening capabilities.

Keywords
Ischemic stroke
Prevalence
Incidence
Disability adjusted life years
Epidemiology
Funding
This work was supported by the Clinical and Translational Medicine Research Project of the Chinese Academy of Medical Sciences (2022-LC04).
Conflict of interest
Yan Yao is one of the Editors-in-Chief of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Other authors declare that they have no competing interests.
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