Global Stroke Burden from Metabolic Risks Across Demographics: Findings from the 2021 Global Burden of Disease Study

Background: Stroke is the second leading cause of death and the primary cause of disability worldwide. Metabolic risks are major contributors to stroke. The global trends in metabolic risk-related stroke from 1990 to 2019, and the differences in mortality and DALYs across various demographic factors, remain unclear. Methods: All analyses were based on rates derived from the GBD2021 results (https://vizhub.healthdata.org/gbd-results/). Data were stratified by gender, region, and age. Joinpoint software was used to perform regression analysis of the average annual percent change (AAPC) and its 95% confidence interval to analyze trends from 1990 to 2019. Excel, PowerPoint, and R software were used for plotting and analysis, with p<0.05 considered statistically significant. Results: From 1990 to 2019, the average annual percent change (AAPC) for age-standardized rates (ASR) of DALYs was -1.70% (-1.81%, -1.58%), and for mortality, the AAPC was -1.57% (-1.68%, -1.46%). As the SDI increased, both the ASR of DALYs and mortality in 2019 showed a significant decline. The AAPC from 1990 to 2019 also exhibited a downward trend with increasing SDI levels. The DALYs and mortality rates of metabolic risk-related stroke predominantly affected individuals aged 75 and above, with a lesser impact on those under 55. For both genders, the 10-55 and 50-74 age groups had the highest DALYs and mortality rates due to metabolic-related intracerebral hemorrhage. For those aged 75-84 and over 85, ischemic stroke was the leading subtype of metabolic-related stroke contributing to DALYs and mortality rates. Conclusion: This is the first retrospective study on metabolic risk-related stroke on a global scale, summarizing its temporal trends and demographic distribution characteristics. Effective public health strategies are needed to address these disparities and continue reducing the global burden of metabolic risk-related strokes.