Lu Huan, Zhang Wenhao
The Second Affiliated Hospital of Bengbu Medical University, Bengbu, China.
Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, China.
BMC Public Health. 2025 Aug 21;25(1):2872. doi: 10.1186/s12889-025-23869-9.
The global burden of stroke among women of reproductive age is of significant concern. We aimed to leverage the Global Burden of Disease 2021 (GBD 2021) to estimate the prevalence, Years Lived with Disability (YLDs), and Disability-Adjusted Life Years (DALYs) rates for pathological types of strokes in women of reproductive age, as well as to examine their association with the sociodemographic index (SDI).
We utilized stroke data for women of reproductive age from 204 countries and territories from 1990 to 2021. The Annual Percentage Change (APC) was calculated, and the Average Annual Percentage Change (AAPC) was estimated to analyze trends in the burden of stroke. APC was used to measure the change in indicators over specific time intervals, assisting in describing the annual average rate of change in disease trends or other health metrics, and thereby providing insights into the direction and magnitude of disease burden changes. AAPC, typically derived as the weighted average of APC over a period, was used to assess long-term trends in time-series data, reflecting the overall trend while mitigating the influence of short-term fluctuations. This approach provides a solid basis for disease burden research and public health policy making. Additionally, the study explored the impact of risk factors for different pathological types on DALYs rates across various age groups and the 27 GBD super-regions. Statistical significance was set at P < 0.05. The analyses were conducted using the Joinpoint Trend Analysis Software and R 4.4.2.
The overall burden of stroke in women of reproductive age worldwide shows a downward trend, with the prevalence rate of AAPC at -0.22, YLDs rate of AAPC at -0.33, and DALYs rate of AAPC at -1.27. However, the prevalence of ischemic stroke showed an upward trend, with an AAPC of 0.08. In 2021, the Nauru region bore the highest burden of stroke in women of reproductive age, with prevalence, YLDs, and DALYs rates reaching 1,223.56 (95% UI: 1,180.50 to 1,271.92), 241.44 (95% UI: 173.40 to 311.30), and 2,646.68 (95% UI: 1,977.34 to 3,663.05), respectively. Our analysis revealed that the indicators for ischemic stroke and intracerebral hemorrhage (ICH) generally declined over time and with increasing SDI values, whereas the burden of subarachnoid hemorrhage (SAH) initially increased before decreasing. When analyzing different age groups, we found that the burden of stroke in women of reproductive age increases with age. Between 1990 and 2021, the stroke burden decreased across all age groups within the reproductive years. The 15-19 age group exhibited the most significant decrease in prevalence rate, with an AAPC of -0.59; the 20-24 age group showed the most notable decline in YLDs rate, with an AAPC of -0.87; and the 35-39 age group experienced the largest reduction in DALYs rate, with an AAPC of -1.82. We identified 23 risk factors associated with stroke-related DALYs in reproductive-aged women. Compared with 1990, the strength of the associations between metabolic risk factors and stroke-related disability-adjusted life years was greater in 2021, with "High systolic blood pressure" and "High LDL cholesterol" demonstrating the most pronounced links. Moreover, trend analyses from 1990 to 2021 indicated that the associations of "Diet high in sugar-sweetened beverages" (AAPC = 2.33), "High body-mass index" (AAPC = 1.81), "High temperature" (AAPC = 0.77), and "High fasting plasma glucose" (AAPC = 0.51) with stroke-related DALY rates increased significantly over time. "Ambient particulate matter pollution" did not exhibit a statistically significant association, and the remaining seventeen risk factors showed declining trends in their associations.
While the global burden of stroke in women of reproductive age has decreased, significant burdens remain in certain regions and age groups compounded by multiple risk factors. Understanding these trends will help to guide future policy recommendations aimed at alleviating the associated burden.
育龄女性的全球中风负担备受关注。我们旨在利用《2021年全球疾病负担》（GBD 2021）来估计育龄女性中风病理类型的患病率、残疾生存年数（YLDs）和伤残调整生命年（DALYs）率，并研究它们与社会人口指数（SDI）的关联。
我们使用了1990年至2021年来自204个国家和地区的育龄女性中风数据。计算了年度百分比变化（APC），并估计了平均年度百分比变化（AAPC）以分析中风负担的趋势。APC用于衡量特定时间间隔内指标的变化，有助于描述疾病趋势或其他健康指标的年度平均变化率，从而洞察疾病负担变化的方向和幅度。AAPC通常作为一段时间内APC的加权平均值得出，用于评估时间序列数据的长期趋势，反映总体趋势同时减轻短期波动的影响。这种方法为疾病负担研究和公共卫生政策制定提供了坚实基础。此外，该研究探讨了不同病理类型的风险因素对各年龄组和27个GBD超级区域DALYs率的影响。设定统计学显著性为P < 0.05。使用Joinpoint趋势分析软件和R 4.4.2进行分析。
全球育龄女性中风的总体负担呈下降趋势，AAPC患病率为 -0.22，AAPC YLDs率为 -0.33，AAPC DALYs率为 -1.27。然而，缺血性中风的患病率呈上升趋势，AAPC为0.08。2021年，瑙鲁地区育龄女性中风负担最高，患病率、YLDs和DALYs率分别达到1223.56（95% UI：1180.50至1271.92）、241.44（95% UI：173.40至311.30）和2646.68（95% UI：1977.34至3663.05）。我们的分析表明，缺血性中风和脑出血（ICH）的指标总体上随时间推移和SDI值增加而下降，而蛛网膜下腔出血（SAH）的负担最初增加后下降。在分析不同年龄组时，我们发现育龄女性中风负担随年龄增加。1990年至2021年期间，生育年龄段内所有年龄组的中风负担均下降。15 - 19岁年龄组患病率下降最为显著，AAPC为 -0.59；20 - 24岁年龄组YLDs率下降最为明显，AAPC为 -0.87；35 - 39岁年龄组DALYs率下降幅度最大，则AAPC为 -1.82。我们确定了23个与育龄女性中风相关DALYs有关的风险因素。与1990年相比，2021年代谢风险因素与中风相关残疾调整生命年之间的关联强度更大，“高收缩压”和“高LDL胆固醇”的关联最为明显。此外，1990年至2021年的趋势分析表明，“高糖饮料饮食”（AAPC = 2.33）、“高体重指数”（AAPC = 1.81）、“高温”（AAPC = 0.77）和“高空腹血糖”（AAPC = 0.51）与中风相关DALY率的关联随时间显著增加。“环境颗粒物污染”未表现出统计学显著关联，其余17个风险因素的关联呈下降趋势。
虽然全球育龄女性中风负担有所下降，但某些地区和年龄组仍存在重大负担，且有多种风险因素叠加。了解这些趋势将有助于指导未来旨在减轻相关负担的政策建议。
