Frontiers in Neurology · May 22, 2026

Global, regional, and national burden of disease for high BMI-related ischemic stroke in people aged 70 and older: trend analysis from 1990 to 2021 and projections for 2044

By Huang Z, Min Y, Zhang G et al.

BACKGROUND: Ischemic stroke (IS) remains a leading cause of death and long-term disability worldwide. In older adults, metabolic risk factors have become increasingly significant, with high body mass index (BMI) contributing notably to the burden of IS. Although recent GBD-based studies have described the burden of high BMI-attributable ischemic stroke (HB-IS) across broader populations, they do not fully capture heterogeneity within adults aged ≥ 70 years. In this age group, cross-national inequalities, within-elderly age gradients, SDI- and sex-specific temporal patterns, and future trajectories under population aging remain insufficiently characterized. METHODS: Using Global Burden of Disease 2021 estimates for 1990-2021, we quantified HB-IS deaths, disability-adjusted life years (DALYs), and population-attributable fractions (PAFs) among adults aged ≥ 70 years by sex, age, country, and socio-demographic index (SDI). Temporal trends were assessed using segmented log-linear regression with BIC-selected breakpoints, and period differences were summarized using period rate ratios (PRRs). Changes in deaths were decomposed using a Shapley-based approach into population growth, population aging, and rate change. Deaths were projected for 2022-2044 using empirical age-specific log-linear extrapolation with hindcasting-based validation. RESULTS: In 2021, death rates ranged from 3.93 to 124.33 per 100,000 and DALY rates from 52.32 to 2085.76 per 100,000; PAFs was 0.53%-10.39% for deaths and 0.64%-11.34% for DALYs. DALY rates declined globally, driven by high-SDI regions, whereas low and low-middle SDI regions rose or stagnated. Within the ≥70-year population, DALY rates generally increased with age, and trends were generally less favorable in lower-SDI settings and among males. Deaths increased from 55,302 in 1990 to 83,007 in 2021. Under continuation of recent trends, model consistent forecasts projected deaths to reach 104,638 by 2044 despite falling rates, with growth increasingly concentrated in those aged ≥80 years. CONCLUSION: HB-IS among adults aged ≥ 70 years shows marked geographic, SDI-, sex-, and age-related disparities; despite falling rates, population growth and accelerated aging are likely to increase the absolute burden, supporting SDI-tailored and age-/sex-sensitive prevention and care.

doi.org/10.3389/fneur.2026.1794665Open accessPubMed 42256569Populations