# A Three-Decade Analysis of Ischemic Stroke in India: Mortality, Morbidity, and Risk Factors Using the Global Burden of Diseases Study from 1990 to 2019

## TL;DR

This study examines how ischemic stroke cases, deaths, and risk factors in India changed from 1990 to 2019, showing a significant rise in incidence but some improvements in mortality.

## Contribution

The study provides a three-decade analysis of ischemic stroke trends in India using the Global Burden of Disease data, highlighting sex-based disparities and risk factors.

## Key findings

- Incident stroke cases in India increased by 118.8% from 1990 to 2019, with higher rises in females than males.
- Stroke deaths rose by 148.5%, but age-standardized rates for mortality and YLLs decreased, indicating improved healthcare.
- Metabolic risks, pollution, and tobacco smoking were identified as major contributors to the stroke burden.

## Abstract

Background/Objectives: India has experienced a sharp increase in stroke burden over the last half-century. The diverse geographical conditions and developing health infrastructure warrant an investigation into changes in mortality and morbidity due to ischemic stroke. This research aims to estimate the impact of attributable risk factors, providing comprehensive insights into the temporal trends of ischemic stroke in India. Methods: Data regarding ischemic stroke in India were queried from the 2019 Global Burden of Disease (GBD) study. Age-standardized deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), prevalence, and incidence were collected and analyzed. Descriptive statistics and 95% uncertainty intervals (UI) were utilized to ensure reliability. Results: In 2019, there were 535,700 incident stroke cases in India (95% CI 453,200–631,800), marking a 118.8% increase from 1990. Females saw a higher incidence rise (131.1%) than males (107.5%). The incidence rate reached 38.5 per 100,000 (95% CI 32.6–45.4), a 34.6% increase, while the age-standardized incidence rate declined by 4.2%. Stroke deaths rose by 148.5%, totaling 271,200 (95% CI 227,800–320,700). Females experienced a higher increase (183.5%) than males (123.0%). Prevalence increased by 130.4%, reaching 6,465,700 cases (95% CI 5,541,000–7,378,000), while age-standardized prevalence rose by 5.7%. Disability-adjusted life years (DALYs) increased by 121.0% to 5,689,300 (95% CI 4,821,100–6,649,500), but the age-standardized DALY rate fell by 23.1%. Years lived with disability (YLD) increased by 135.5% to 907,000 (95% CI 640,300–1,172,900). Years of life lost (YLL) rose by 118.4% to 4,782,300 (95% CI 3,945,500–5,743,700), but the age-standardized YLL rate fell by 26.3%. Metabolic risks, ambient particulate matter pollution, and tobacco smoking were significant risk factors contributing to stroke burden. Conclusions: This study highlights contrasting trends in ischemic stroke indicators in India from 1990 to 2019. While prevalence and YLDs have increased, the overall decline in mortality, YLLs, DALYs, and stroke incidence points to improvements in healthcare access and treatment. There is a need for targeted public health interventions to address the growing stroke burden, mainly focusing on preventive measures and addressing sex-based disparities.