Burden of stroke in the United States of America, 1990–2021: a systematic analysis for the US burden of disease study 2021

Objectives: Accurate and updated stroke burden estimates are essential to inform public health interventions and resource allocation in the United States (US). We aimed to evaluate the burden of ischemic and hemorrhagic stroke in the US in 2021 and analyze trends from 1990 to 2021 by age, sex, and geographic location. Methods: This was a comprehensive analysis based on the 2021 Global Burden of Disease (GBD) study encompassing ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs), including absolute numbers and age-standardized rates per 100,000 population, were stratified by stroke subtype, sex, age, and geographic region. Results: In 2021, there were 0.41 million incident strokes (95% uncertainty interval (UI), 0.36–0.47 million), predominantly ischemic (0.31 million, 75.6%). The prevalence was 6.3 million, with ischemic stroke accounting for 78% (3.07 million, 48.7% men). Hemorrhagic strokes included 0.75 million ICH and 0.45 million SAH. Stroke deaths totaled 0.19 million, with DALYs of 3.91 million. From 1990 to 2021, the crude stroke prevalence markedly increased for ischemic stroke (65.7%), ICH (78.3%), and SAH (70.6%). Although age-standardized incidence and mortality rates generally decreased over this period, the incidence of SAH has increased recently, and hemorrhagic stroke mortality peaked around 2000. Younger populations (aged 15–49 years) experienced an increasing stroke burden, especially in Alaska and Arkansas, highlighting demographic and regional disparities. Conclusion: Despite improvements in age-standardized stroke incidence, mortality, and DALYs, the overall burden of stroke continues to increase owing to demographic shifts and the increasing prevalence of risk factors. There is a critical need for tailored and targeted interventions to address the evolving demographic and regional disparities and effectively reduce the US stroke burden.