Risk factors attributable to ischemic stroke burden in Brazil: a global burden of disease based analysis

Abstract

Background: Worldwide, ischemic stroke is a leading cause of death and long-term disability, disproportionately affecting low- and middle-income populations. Hypertension and atrial fibrillation are key independent determinants, while diabetes, dyslipidemia, smoking, obesity, and physical inactivity have greater impact when combined. These risks vary across regions due to socioeconomic disparities, healthcare access, prevention, and aging. Understanding the interaction between non-modifiable and modifiable factors is essential to guide prevention and reduce outcome inequalities. Coordinated public health action remains essential. Objective: To analyze the burden of ischemic stroke in Brazil, measured by disability-adjusted life years (DALYs), years lived with disability (YLDs), and mortality, according to the attribution of metabolic, behavioral, and environmental risk factors based on Global Burden of Disease (GBD) estimates. Methods: For the analysis of DALYs, YLDs, and mortality attributable to ischemic stroke according to risk factor attribution from the Global Burden of Disease (GBD), a descriptive approach was used, with results expressed as absolute (n) and relative (%) frequencies. Proportions were calculated in relation to the total number of events and, when applicable, to the total attributable to risk factors Results: Of the 1,128,218 DALYs attributable to risk factors, 49.96% were attributed to metabolic factors, 4.59% to behavioral factors and 2.33% to environmental factors when analyzed individually. Among the 59,658 deaths attributable to risk factors, metabolic factors predominated, accounting for 53.78% of mortality according to GBD attribution, followed by behavioral (4.15%) and environmental factors (2.80%). A total of 142,534 YLDs were estimated with metabolic factors accounting for 49.33% of the attributable disability burden, compared with 4.89% for behavioral factors and 1.77% for environmental factors. The association between metabolic and behavioral factors constituted the second largest attributable group, representing 26.32% of DALYs, 22.10% of deaths, and 29.30% of YLDs, with a proportionally greater contribution to the disability component. The combination of environmental and behavioral factors showed comparatively smaller contributions across all indicators. Conclusion: The burden of ischemic stroke in Brazil is primarily driven by modifiable risks, with metabolic factors accounting for the largest share of mortality and overall burden. The synergy between metabolic and behavioral risks further aggravates outcomes. A high proportion of YLDs indicates a significant post-stroke disability burden, suggesting that improved survival has not been accompanied by proportional gains in prevention and rehabilitation. These findings underscore the urgency of integrated public health policies that target combined risk profiles, prioritizing not only mortality reduction but also long-term disability prevention.