Global, Regional, and National Burden of Stroke on Children and Adolescents Aged Under 20 Years From 1990 to 2021, With Projections of Disability-Adjusted Life Year to 2050: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2021.

BACKGROUND

Stroke in children is a global epidemic.

METHODS

Data on stroke, including incidence, DALYs, mortality, and associated risk factors from 1990 to 2021, were obtained from the Global Burden of Disease (GBD) study, 2021. Estimated annual percentage changes were calculated to evaluate changes in the age-standardized rates of incidence (ASIR), DALYs (ASDR), and mortality (ASMR), as well as trends by age, sex, and sociodemographic index (SDI). Projections of DALYs to 2050 were made.

RESULTS

In 2021, there were 310,133 incident stroke cases, accounting for 24,807 deaths and 2,414,655 DALYs among children and adolescents. The global ASIR, ASDR, and ASMR for stroke were 11.8, 93.9, and 1.0 per 100,000 population, respectively. Middle-to-low-SDI regions accounted for 81.6% of incident cases, 90.2% of DALYs, and 92.7% of deaths. A reversed V-shaped association was observed between SDI and ASRs. Children < 1 year had the highest ASRs, with rates generally decreasing with age, and the highest incidence of hemorrhagic stroke. Adolescents aged 15-19 years had the highest incidence of ischemic stroke. Non-optimal temperature contributed the most to the DALYs and death rates for stroke. By 2050, it is projected that 282,404 DALYs will be lost due to stroke.

CONCLUSIONS

Stroke burden varies by the GBD region, country, age, sex, and SDI. Despite declines in ASRs, stroke remains a significant burden, especially in middle-to-low-SDI regions, among children < 1 year, and among those with intracerebral hemorrhage. Non-optimal temperature emerges as the leading modifiable risk factor for children stroke; targeted interventions can prevent this.