Comparative analysis of stroke burden between ages 20-54 and over 55 years: based on the global burden of disease study 2019.

backgroundStroke remains one of the major diseases threatening human health and life worldwide. Therefore, it is urgent to investigate the stroke burden in different age groups.

methodsWe described the disease burden of three subtypes of stroke, namely intracranial haemorrhage (ICH), subarachnoid haemorrhage (SAH), and ischaemic stroke (IS), among people aged 20 ~ 54 years and > 55 years from 1990 to 2019, based on data from Global Burden of Disease Study 2019 and calculated the estimated annual percentage changes (EAPC) for age-specific incidence, disability-adjusted life-years (DALYs), mortality and prevalence rates. Joinpoint regression analyzes showed the critical years of trend inflexion points. Decomposition and health inequality analyses determined the impact of different epidemiological factors on stroke burden. Population-attributable fractions were calculated for deaths and DALYs due to risk factors.

resultsFrom 1990 to 2019, the incidence of ICH and SAH decreased by 11.32% and 10.45%, respectively, in the 20-54 age group globally, while the incidence of IS increased by 14.95%. Meanwhile, the incidence of stroke in the > 55 years group showed an overall decreasing trend. The burden of adverse outcomes, including death and DALYs, varied by stroke subtype, with the rates of mortality and DALYs decreasing significantly less in IS than in ICH and SAH. In addition, the decline in mortality and DALYs rates was consistently greater in the over 55 years age group than in the 20-54 years age group. Notably, the prevalence of ICH, SAH, and IS increased by 20.55%, 11.50%, and 7.38% in the 20-54 years age grouper group, respectively, whereas in the elderly group, there was only a mild increase of IS in the over 55 years group. What is more, stroke burden showed a negative correlation with regional development. Furthermore, high systolic blood pressure was a common contributor to stroke burden in both age groups. The difference is that a high body mass index affects people aged 20-54 years more, while abnormal fasting blood glucose affects older people more.

conclusionThe stroke burden in people 20-54 years of age is increasingly becoming a global health problem, particularly the incidence of IS in lower economic development areas. CLINICAL TRIAL NUMBER: Not applicable.