Global burden and trend of stroke attributable to metabolic risks among young adults (20-39 years old) from 1990 to 2021.

OBJECTIVES

Stroke is increasingly affecting young adults, with metabolic-risk factors playing a critical role in this trend. This study aims to assess the global burden and trends of stroke and its subtypes attributable to metabolic-risks in young adults from 1990 to 2021.

METHODS

Data from the Global Burden of Disease Study (GBD) 2021 were analyzed to assess the disability-adjusted life years (DALYs) attributed to metabolic-risks for stroke and its subtypes in young adults across 204 countries and territories. Estimated annual percentage changes in the age-standardized DALYs rate (ASDR) of stroke, by age, sex, socio-demographic index (SDI), and subtype, were calculated to quantify the temporal trends.

RESULTS

In 2021, metabolic risk factors were responsible for approximately 3,960,349 stroke-DALYs in young adults globally, accounting for 45.44% of the total stroke burden in this group. High systolic blood pressure was the leading contributor (35.43%), followed by high LDL cholesterol (9.13%), high BMI (7.26%), kidney dysfunction (5.47%), and high fasting plasma glucose (2.42%). From 1990 to 2021, the absolute number of stroke-related DALYs attributable to metabolic-risks increased by 22.23%, while the ASDR decreased by 0.78% annually. Regional disparities were evident, with East Asia reporting the largest number of stroke-DALYs attributable to metabolic-risks and Southeast Asia exhibiting the highest ASDR. Notably, the proportion of stroke-DALYs attributable to metabolic-risks showed a positive association with SDI and increased across all regions during the study period. The most notable increases were observed in Eastern Europe. By stroke subtype, metabolic risk factors contributed to 1,147,521 DALYs from ischemic stroke, 2,267,874 from intracerebral hemorrhage, and 544,954 from subarachnoid hemorrhage in 2021. The ASDR of all subtypes declined from 1990 to 2021, with the steepest decline for subarachnoid hemorrhage (EAPC = -1.37%). However, ASDR increased in specific regions, notably Sub-Saharan Africa for ischemic stroke and the Caribbean and Oceania for intracerebral hemorrhage and subarachnoid hemorrhage.

CONCLUSIONS

Despite a decline in ASDR, the absolute burden of stroke attributable to metabolic risks among young adults has increased globally, with significant regional and national disparities. Targeted prevention strategies addressing metabolic risk factors are urgently needed, particularly in high-burden regions.