1990年至2021年青年成人卒中的全球负担及风险因素：全球疾病负担研究2021的系统分析

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021.

作者信息

Zhang Min, Long Zhiping, Liu Peifang, Qin Qi, Yuan Heli, Cao Yukun, Jia Yanjie, Liu Xiao, Yu Yue, Wu Yi, Pei Bing, Ye Jingyu, Wang Maoqing, Wang Fan

机构信息

Department of Epidemiology, School of Public Health Harbin Medical University Harbin Heilongjiang Province P. R. China.

Department of Neurology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province P. R. China.

出版信息

J Am Heart Assoc. 2025 May 20;14(10):e039387. doi: 10.1161/JAHA.124.039387. Epub 2025 May 15.

DOI:10.1161/JAHA.124.039387

PMID:40371619

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12184566/

Abstract

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

摘要

背景

本研究旨在估计1990年至2021年期间204个国家和地区的年轻成年人（15 - 49岁）中缺血性卒中、脑出血、蛛网膜下腔出血及总体卒中的疾病负担，以及相关危险因素。

方法

采用全球疾病负担研究（GBD）2021数据，通过年龄标准化率及其估计的年百分比变化来评估负担和趋势。

结果

尽管从1990年到2021年年龄标准化率总体呈下降趋势，但年轻成年人中卒中的发病和患病病例数分别增加了36%（95%不确定区间，31% - 41%）和41%（95%不确定区间，38% - 43%）。值得注意的是，2015年至2021年期间，年轻成年人中缺血性卒中和蛛网膜下腔出血的年龄标准化发病率有所上升，估计年百分比变化分别为0.65（95%置信区间，0.39 - 0.92）和0.58（95%置信区间，0.47 - 0.69）。高收缩压是年轻成年人中与卒中相关的伤残调整生命年的主要危险因素。然而，其他危险因素因地区而异，在社会人口学指数较高的地区，吸烟、高低密度脂蛋白胆固醇和高体重指数的比例较高，而在社会人口学指数较低的地区，固体燃料造成的家庭空气污染和蔬菜摄入量低的饮食比例较高。从1990年到2021年，由于危险因素导致的年轻成年人中与卒中相关的伤残调整生命年总数增加了12%（95%不确定区间，2% - 22%），主要由高收缩压、环境颗粒物污染、高体重指数、高低密度脂蛋白胆固醇和高空腹血糖驱动。