Incidence trend and age-period-cohort model analysis of ischemic strokes in the global middle-aged population from 1990 to 2021

HAO Guangzhi; DONG Yushu; ZHANG Bingying; SUN Linlin; XIONG Jian

Abstract：Objective To analyze the incidence trend of ischemic stroke among the global middle-aged population from 1990 to 2021,and further investigate the influences of age,period,and cohort on ischemic stroke incidence,which can provide valuable insights for the prevention of ischemic stroke in middle-aged individuals worldwide.Methods Incidence rates,crude incidence rates,and standardized incidence rates of ischemic strokes were extracted from the Global Burden of Disease Database 2021 for individuals aged 40-64 years.The Joinpoint regression model was employed to assess trends in standardized incidence over a span of 32 years(1990-2021).Annual percentage change(APC)and average annual percentage change(AAPC)were utilized for result evaluation.Additionally,an age-period-cohort model was applied to analyze the effects of age,period,and cohort on global incidences of strokes among middle-aged populations.Results From 1990 to 2021,the incidence number of ischemic strokes in middle-aged people increased from 1,340,634 cases to 2,326,850 cases,with an increase rate of 73.56%.The crude incidence rate decreased from 124.47 per 100,000 to 109.01 per 100,000,a reduction of 84.21%,and the standardized incidence rate decreased from 125.71 per 100,000 to 107.49 per 100,000,a reduction of 14.49%.Joinpoint regression model analysis showed that within the overall population,male and female standardized incidence had a decreasing trend.The segment point of the overall group occurred in 1995,2000,2005,2015 and 2019,and the AAPC value was-0.51%(P<0.01).The global net drift(95%CI)was-0.52%(-0.55%,-0.49%)and all the local drift values were all below zero,and it decreased with the increase of age,reaching the lowest value of-0.81%at the age of 60-64 years segment.Conclusions Through the analysis of the data from the Global Burden of Disease Database 2021,a comprehensive assessment of the global burden of ischemic strokes among middle-aged individuals from 1990 to 2021 is made for the first time.The incidence of ischemic strokes in this demographic group has been rising annually,indicating a significant disease burden.Notably,there is a marked increase in incidence within the male population,underscoring the necessity for gender-specific preventive strategies to mitigate the impact of ischemic strokes.