Sex disparities and trends in stroke incidence, prevalence, and mortality in the US and worldwide: Findings from the global burden of disease, 1990-2021

Background: Stroke is a leading cause of death/disability, with notable differences in incidence, prevalence, and mortality observed. Despite advancement in stroke research, notable gaps persist in understanding the overall trend and sex-specific disparities in stroke burden over the past three decades, both in the United States of America (USA) and globally. Aims: This observational-study aims to investigate evolving trends and sex-specific disparities in the incidence, prevalence, and mortality of stroke in the USA and globally from 1990 to 2021. Methods: Leveraging data from the Global Burden of Disease database, we calculated age-standardized incidence (ASIR), prevalence (ASPR), and mortality (ASMR) rates per 100,000 individuals for stroke in the USA and globally, stratified by sex and type of stroke. Joinpoint regression analysis was employed to assess the annual percent changes (APCs) in ASIR, ASPR, and ASMR, with 95 % confidence interval. Average annual percentage changes (AAPCs) were subsequently computed as weighted averages of the APCs. Statistical significance was defined as a p-value < 0.05. Results: From 1990 to 2021, the ASIR of stroke in the USA exhibited a significant decline from 113.45 to 75.64 per 100,000, marking a 33.3% reduction. Globally, ASIR decreased from 180.97 to 141.55, reflecting a 21.8% reduction. Furthermore, The ASPR from 1990 to 2021 in the USA slightly decreased of 1.7%, while globally, it was 8.5%. Additionally, The ASMR from 1990 to 2021 in the USA declined by 31%, from 44.05 to 30.27, whereas globally, from 144.31 to 87.45, representing a 39% reduction. Similar patterns were observed across sexes for incidence, prevalence, and mortality of stroke. Males demonstrated marginally higher rates compared to females across all parameters, with a diminished sex disparity noted across the examined variables. Conclusion: Despite a downward trend in stroke incidence, prevalence, and mortality rates observed both in the United States and globally, these rates continue to be notably elevated, with a male dominance but reduced sex gap. Targeted interventions and strengthened international collaboration are essential for effectively addressing these elevated rates and disparities, thereby mitigating the global and national stroke burden.