Health · Meta-analysis

Ischemic stroke burden remains high in middle-income regions worldwide

• In 2021, ischemic stroke affected about 70 million people globally, with rates varying significantly by region and income level.
• Middle-income countries experienced the highest rates of stroke prevalence, incidence, and death, while high-income countries had the lowest rates.
• Eastern Europe, Central Asia, and Sub-Saharan Africa bore the greatest burden from ischemic stroke measured by mortality and disability.

EClinicalMedicine · 2024 — https://doi.org/10.1016/j.eclinm.2024.102758

Global, regional, and national burden of ischemic stroke, 1990–2021: an analysis of data from the global burden of disease study 2021

What this study is about

This study looks at "ischemic stroke" around the world. An ischemic stroke happens when blood flow to part of the brain gets blocked, kind of like a clogged pipe stopping water from reaching part of a garden. When brain cells don't get blood, they can get hurt.

Scientists wanted to know how common ischemic stroke was in the year 2021, and how things changed from 1990 to 2021. They looked at four things: how many people currently have had a stroke ("prevalence"), how many new cases happen ("incidence"), how many people die from it ("mortality"), and how much healthy life is lost because of it (called "DALYs," which stands for years lost to poor health or early death).

They compared countries and regions, and also grouped places by something called the "Socio-demographic Index" (SDI). Think of SDI like a scorecard that combines a country's income, education levels, and birth rates, to sort places into groups from lowest to highest development. They split the world into five SDI groups, from "high SDI" (most developed) down to "low SDI."

What they found

In 2021, ischemic stroke was still a big problem worldwide. Almost 70 million people around the world had experienced it.

The interesting part: the places with the worst numbers were not the richest or the poorest countries. Instead, "high-middle SDI" regions (places in the middle-upper range of development) had the highest rates of stroke cases, new cases, deaths, and lost healthy years. The wealthiest ("high SDI") regions actually had the lowest rates.

Looking at specific parts of the world, Southern Sub-Saharan Africa had the highest rate of existing stroke cases. Eastern Europe had the highest rate of new stroke cases. Eastern Europe, Central Asia, North Africa, and the Middle East had the highest rates of stroke deaths and lost healthy years.

Looking at individual countries, Ghana had the highest rate of existing cases, and North Macedonia had the highest rates of new cases, deaths, and lost healthy years.

What it means for you

This study doesn't test a treatment or tell you something you should personally do differently, like eat less salt or exercise more. It's a big-picture counting study, it measures how much of a problem ischemic stroke is in different parts of the world.

The main message is that stroke isn't just a problem for poor countries or rich countries. Middle-income and "high-middle" development regions are carrying an especially heavy burden. That matters because it can help doctors, scientists, and governments figure out where more help, resources, or research money should go, especially in places like Eastern Europe, Central Asia, North Africa, the Middle East, and Southern Sub-Saharan Africa.

For you personally, the main takeaway is simply this: knowing where a health problem hits hardest is an important first step. It doesn't replace things like talking to a doctor about your own health, but it helps the world understand where to focus its efforts to reduce stroke in the future.