International journal of surgery (London, England) · 2025
Global, regional, and national burden of stroke and associated risk factors among adults aged ≥60 years, 1990-2021: a multidimensional analysis leveraging GBD, NHANES, and mendelian randomization.
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Zhang Dameng, Dong Xiangyu, Meng Yao, Yao Zhongyu, Wu Xi
Аннотация
BACKGROUND: Stroke among elderly populations has increasingly emerged as a significant global health concern over recent decades. Nevertheless, there remains a paucity of thorough investigations specifically addressing the stroke burden within this age group. The objective of this study is to provide an in-depth evaluation of the global burden associated with stroke, analyze various stroke subtypes in populations aged 60 years and above during the period from 1990 to 2021, pinpoint potential risk determinants, and forecast stroke incidence trends until 2050.
METHODS: Disability-adjusted life years (DALYs) related to stroke among adults aged ≥60 years between 1990 and 2021 were analyzed using the most recent data available from the Global Burden of Disease Study (GBD). Projections for future stroke prevalence and its subtypes spanning the years 2022 to 2050 were developed utilizing the Bayesian age-period-cohort (BAPC) modeling technique. Furthermore, logistic regression analyses leveraging data from the National Health and Nutrition Examination Survey (NHANES) assessed the correlation between stroke occurrence, body mass index (BMI), and glucose levels. Additionally, Mendelian randomization (MR) was applied to infer causative associations.
RESULTS: Between 1990 and 2021, there was an 86.79% increase in stroke cases and a 46.32% increase in DALYs among elderly individuals. Conversely, declining trends were observed in the age-standardized incidence rate (ASIR) and age-standardized disability rate (ASDR). In 2021, hemorrhagic stroke contributed the largest proportion of DALYs (49.6%). Southeast Asia experienced the highest stroke burden, whereas high-income regions recorded the lowest burden. According to projections from the BAPC model, ASDR is expected to continue decreasing up to 2050. Both logistic regression and MR analyses demonstrated significant associations between increased BMI, elevated blood glucose levels, and stroke risk.
CONCLUSIONS: Although the ASDR has decreased globally, the stroke burden among the elderly in low-income countries still warrants high attention.
METHODS: Disability-adjusted life years (DALYs) related to stroke among adults aged ≥60 years between 1990 and 2021 were analyzed using the most recent data available from the Global Burden of Disease Study (GBD). Projections for future stroke prevalence and its subtypes spanning the years 2022 to 2050 were developed utilizing the Bayesian age-period-cohort (BAPC) modeling technique. Furthermore, logistic regression analyses leveraging data from the National Health and Nutrition Examination Survey (NHANES) assessed the correlation between stroke occurrence, body mass index (BMI), and glucose levels. Additionally, Mendelian randomization (MR) was applied to infer causative associations.
RESULTS: Between 1990 and 2021, there was an 86.79% increase in stroke cases and a 46.32% increase in DALYs among elderly individuals. Conversely, declining trends were observed in the age-standardized incidence rate (ASIR) and age-standardized disability rate (ASDR). In 2021, hemorrhagic stroke contributed the largest proportion of DALYs (49.6%). Southeast Asia experienced the highest stroke burden, whereas high-income regions recorded the lowest burden. According to projections from the BAPC model, ASDR is expected to continue decreasing up to 2050. Both logistic regression and MR analyses demonstrated significant associations between increased BMI, elevated blood glucose levels, and stroke risk.
CONCLUSIONS: Although the ASDR has decreased globally, the stroke burden among the elderly in low-income countries still warrants high attention.