Stroke Burden, Trends, and Inequalities in the Western Pacific Region, 1990-2021: A Population-Based Study.
TL;DR
Despite declining age-standardized DALY rates, population aging and growth drove absolute burden increases and Persistent inequality and substantial environmental risks necessitate targeted, context-specific stroke prevention strategies.
Abstract
Background
Population aging in the Western Pacific Region (WPR) is reshaping stroke epidemiology.
Objectives
The authors aimed to assess long-term trends, drivers, cross-country inequalities, and environmental contributions to stroke and its subtypes across 31 WPR countries and areas (1990-2021).
Methods
Using Global Burden of Disease 2021 data, we extracted prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) for overall stroke, ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). We evaluated trends via Joinpoint regression, decomposed DALY changes, assessed sociodemographic index (SDI)-related inequalities, and estimated environmental-attributable burden.
Results
In 2021, the WPR had 34.56 million (95% uncertainty interval [UI]: 32.11-37.21) prevalent cases and 64.53 million (95% UI: 55.68-73.44) DALYs. Prevalent cases were primarily IS (26.47 million [95% UI: 24.00-28.97]; 76.00%), followed by ICH (5.95 million [95% UI: 5.34-6.58]; 17.10%) and SAH (2.40 million [95% UI: 2.17-2.64]; 6.90%). For DALYs, ICH contributed 51.62% (33.31 million [95% UI: 28.50-38.65]), IS 43.38% (27.99 million [95% UI: 24.16-31.66]), and SAH 5.00% (3.23 million [95% UI: 2.59-3.81]). From 1990 to 2021, the age-standardized prevalence rates increased from 1,245.77 (95% UI: 1,165.24-1,336.06) to 1,269.37 (95% UI: 1,185.10-1,358.96) per 100,000, whereas the age-standardized DALY rates declined from 4,155.11 (95% UI: 3,707.13-4,597.72) to 2,326.92 (95% UI: 2011.86-2,645.09) per 100,000. Absolute DALYs increased, driven by population aging (219.51%) and growth (70.27%). Lower-SDI countries exhibited greater absolute inequalities. Environmental exposures accounted for 43.78% of DALYs, led by ambient particulate matter pollution (22.22%).
Conclusions
Despite declining age-standardized DALY rates, population aging and growth drove absolute burden increases. Persistent inequality and substantial environmental risks necessitate targeted, context-specific stroke prevention strategies.