Global burden of male smoking-induced stroke, 1990-2021, and 20-year projections: an analysis of the 2021 Global Burden of Disease Study.

BACKGROUND

Stroke represents the third most prevalent cause of mortality on a global scale. It is well-documented that smoking constitutes a significant risk factor for stroke, with males accounting for a higher proportion of the global smoking population than females. The present analysis thus focused on the global burden of stroke due to smoking in males over the period 1990-2021, with projections made for future trends in stroke due to smoking in males over the next 20 years.

METHODS

Data concerning the burden of stroke attributable to male active smoking from 1990 to 2021 were retrieved from the Global Burden of Disease Study (GBD) platform. The mean annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of stroke due to male smoking in different regions were calculated as a means of assessing the global disease burden of stroke due to male smoking. To this end, global population projections for 2021-2041 were obtained from realistic and projected demographic databases, and Bayesian age-period-cohort analysis (BAPC) modeling was used to predict future trends in male smoking-attributed stroke over the next 20 years.

RESULTS

The global age-standardized mortality rate (ASMR) for stroke due to smoking in men exhibited a decline from 33.45/100,000 (95% UI 27.84-39.70) in 1990 to 18.76/100,000 (95% UI 15.23-22.76) in 2021 [EAPC - 1.97 (95% UI -2.03 ~ -1.91)]. The age-standardized disability-adjusted life-years (DALYs) rate (ASDR) for smoking-induced stroke in men exhibited a decline between 1990 and 2021. The burden of smoking-induced stroke was found to be higher among men in the 45 + age group in 2021 compared with 1990. Furthermore, in 2021, the ASMR and ASDR for smoking-induced stroke in men were found to be lowest in high SDI regions. Concurrently, substantial geographic and regional disparities emerged, with the ASMR reaching its peak in East Asia and its nadir in Australasia in 2021. Furthermore, both ASMR and DALYs for male smoking-attributed stroke exhibited a downward trend over the subsequent two decades.

CONCLUSION

ASMR and ASDR for stroke due to smoking in men are declining globally, but there are marked differences between different regions of the world and between different age groups of men. It is recommended that future studies focus on developing countries with lower income levels and on smoking men over the age of 45 years to reduce the burden of smoking-related stroke in men.