AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Rising Absolute Burden of Ischemic Stroke in the United States and Worldwide, 1990-2023: Findings from the Global Burden of Disease 2023 Data
By teena F, Kumar P, Ratan P et al.
Introduction: Ischemic stroke remains a leading cause of death and disability. We characterized global and U.S. trends in ischemic stroke from 1990 to 2023, with emphasis on absolute burden, age-standardized rates, and age and sex. Methods: Using Global Burden of Disease 2023 estimates, we analyzed incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) globally and in the United States by sex and age. Age-standardized rates (ASRs) were expressed per 100,000. Percentage changes and joinpoint average annual percent changes (AAPCs) were calculated. Results: Globally, ischemic stroke incidence, prevalence, deaths, and DALYs increased from 4.58 to 8.45 million (+84.5%), 37.44 to 77.78 million (+107.7%), 2.56 to 3.27 million (+27.7%), and 51.84 to 66.95 million (+29.1%), respectively. In the United States, corresponding increases were 304,213 to 388,155 (+27.6%), 3.48 to 6.67 million (+91.7%), 99,697 to 118,039 (+18.4%), and 1.88 to 2.46 million (+30.9%). Despite rising counts, global ASRs declined for incidence (121.83 to 94.12; –22.7%; AAPC –0.79), prevalence (915.99 to 862.03; –5.9%; –0.19), mortality (78.85 to 36.95; –53.1%; –2.22), and DALYs (1419.46 to 742.32; –47.7%; –1.90; all p<0.001). U.S. ASRs declined for incidence (96.17 to 70.04; –27.2%; AAPC –0.94), mortality (29.78 to 17.75; –40.4%; –1.38), and DALYs (575.17 to 411.32; –28.5%; –0.91), while prevalence increased (1129.46 to 1252.89; +10.9%; +0.34; all p<0.001). In 2023, males had greater global incidence (4.70 vs 3.76 million), prevalence (43.37 vs 34.40 million), and DALYs (35.42 vs 31.54 million), while females had slightly more deaths (1.68 vs 1.59 million). In the United States, males had more incident and prevalent cases (207,294 vs 180,861; 3.46 vs 3.22 million), but females had more deaths and DALYs (72,264 vs 45,774; 1.34 vs 1.11 million). Relative increases were larger in males than females for incidence and DALYs globally (+96.8% vs +71.4%; +40.0% vs +18.8%) and in the United States (+40.4% vs +15.5%; +37.2% vs +25.4%). DALYs peaked at ages 70-74 globally and 80-84 in the United States. Conclusion: From 1990 to 2023, ischemic stroke showed rising absolute burden but declining age-standardized incidence, mortality, and DALY rates. Rising U.S. prevalence, sex-specific differences, and concentration of DALYs among older adults highlight an expanding need for secondary prevention, rehabilitation, and long-term stroke survivorship care.