Global stroke burden keeps climbing even as rates fall

A new Global Burden of Disease study finds stroke rates have dropped over three decades, but the total number of strokes, deaths and disability cases keeps rising worldwide. Researchers say prevention focused only on people labeled high risk is missing most cases and leaves health systems exposed.

Why it matters: - Stroke remains the world's second leading cause of death and third leading cause of death and disability combined. - The study shows a widening gap between lower rates and higher total cases, driven by population growth, aging and rising exposure to risk factors. - Researchers argue current prevention strategies are not reaching enough people to change the global trajectory.

What happened: - A new Global Burden of Disease study in Neuroepidemiology examined global stroke trends from 1990 to 2023. - Researchers led by Professor Valery L. Feigin of Auckland University of Technology estimated 13.2 million new strokes in 2023, 6.8 million deaths and almost 105 million people living with stroke effects. - The latest Global Stroke Fact Sheet 1990–2023 was published in Neuroepidemiology on 7 May 2026.

The details: - From 1990 to 2023, age-standardized stroke mortality fell 52%, DALY rates fell 48% and incidence fell 25%. - Over the same period, the absolute number of new strokes rose 73%, deaths rose 22% and DALYs rose 18%. - Feigin said 52% of strokes now happen in people under 70, reversing the old view of stroke as only a disease of older adults. - An estimated 1.9 million strokes occur each year in people ages 15 to 49. - Researchers link that younger burden to earlier and heavier exposure to metabolic risk factors, especially poorly controlled blood pressure and childhood obesity trends that later show up as adult hypertension and diabetes. - Uncontrolled hypertension remains the single largest driver of stroke worldwide, accounting for about 60% of the global burden. - About half of people prescribed blood-pressure medication stop taking it within months, often after their readings normalize. - Only around 20% of people can feel the physical effects of elevated blood pressure. - Feigin called hypertension a silent killer because many people do not know anything is wrong until they have a stroke or heart attack. - High ambient temperature is emerging as a major contributor, with its share of the stroke burden rising 122% between 1990 and 2023. - High temperature accounted for more than 2.2 million DALYs in 2023, concentrated in North and Central Africa, the Middle East and South Asia. - Low temperature also raises risk, especially in regions historically accustomed to warmth, where cold snaps are now linked to higher stroke and heart attack rates.

Between the lines: - The study suggests screening only people judged to be high risk is too narrow to curb the global burden. - Feigin said even a best-case high-risk strategy prevents only about 11% of strokes and heart attacks because roughly 80% of strokes occur in people classified as low or moderate risk. - Recent reviews of randomized controlled trials found risk screening alone, without follow-up action, does not meaningfully reduce events. - More than 80% of stroke deaths and DALYs occur in low- and middle-income countries, where rising exposure to risk factors, not aging, is driving most of the increase.

What's next: - Feigin is pushing for population-wide prevention, including salt reduction, taxes on sugary drinks and tobacco control. - He also wants individual prevention tools such as smartphone risk-assessment apps that can reach people at any level of risk. - Feigin said health systems need a strategy that treats everyone with even one elevated risk factor, not just those above a high-risk threshold. - The study warns that without a broader approach, stroke trends could overwhelm health systems.

The bottom line: - Stroke rates are falling, but the world is still seeing more strokes, more deaths and more disability. The study says prevention has to expand beyond high-risk screening if that pattern is going to change.

More information: Karger Publishers