Global, Regional, and National Epidemiology of Pediatric Stroke, 1990-2021: A Systematic Analysis From the Global Burden of Disease Study.

Pediatric stroke, although relatively rare, poses considerable health risks with substantial morbidity and mortality. Despite its clinical impact, comprehensive global assessments of its long-term trends and disparities remain limited. Using estimates from the Global Burden of Disease (GBD) 2021 study, we evaluated the burden of pediatric stroke-including both hemorrhagic stroke (HS) and ischemic stroke (IS)-across 204 countries and territories from 1990 to 2021. Our original analyses included the calculation of the estimated annual percentage change (EAPC) of age-standardized rates, stratified by age, sex, and sociodemographic index (SDI). In 2021, there were approximately 2.7 million prevalent pediatric stroke cases worldwide, with HS contributing 41.4% and IS 58.6%. Globally, stroke-related disability-adjusted life years (DALYs) declined from about 5.9 million in 1990 to 2.4 million in 2021. However, the incidence among adolescents aged 10-19 years increased during this period. Marked geographic disparities were observed, with low-SDI regions experiencing disproportionately higher burdens, particularly from HS. India recorded the highest number of DALYs and incident cases in 2021. These findings provide a comprehensive global analysis focused specifically on pediatric stroke, underscoring that although the overall burden has declined, persistent and widening disparities highlight the need for targeted strategies, improved early recognition and strengthened healthcare systems in resource-limited regions.