Burden of ischemic stroke attributed to diet high in sugar-sweetened beverages burdens in 204 countries and territories from 1990--2021

This study aims to explore the relationship between sugar-sweetened beverage (SSB) consumption and ischemic stroke (IS), providing scientific evidence for preventive measures. In this study, a comprehensive analysis based on global burden of disease (GBD) data related to the IS from 1990–2021 was conducted. The time trends of the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) were assessed by estimating the annual percentage change (EAPC). Although the ASMR and ASDR have declined, the global number of deaths and disability-adjusted life years (DALYs) have still shown increasing trends from 1990–2021. There are significant differences in trends between regions with varying social development index (SDI) levels: the ASMR decreases in high-SDI and high–middle-SDI regions but increases in medium-SDI, low–middle-SDI, and low-SDI regions. Additionally, the trends in the 21 regions also exhibited similar patterns. In 2021, China reported the highest number of deaths, whereas Romania and North Macedonia had the highest ASMRs. Countries such as Equatorial Guinea and Ghana showed a significant increasing trend in IS-related mortality caused by SSB. Inequality analysis revealed that from 1990–2021, there was inequality in IS mortality caused by high sugar beverage consumption across SDI regions globally. The mortality rate was higher in high-SDI regions than in low-SDI regions, although the gap gradually narrowed. Further stratified analysis indicated that changes in age structure and population growth had varying impacts across different SDI regions, with epidemiological changes in high-SDI regions contributing more significantly to the mortality rate. In terms of sex, although the mortality rate in men was slightly higher than that in women, the mortality rate in women surpassed that in men in those aged 75 and older. The results from the annual percentage change (APC) model revealed global and regional differences in ischemic stroke mortality rates by SDI and sex, with low-income regions and women facing more serious health challenges. The Bayesian age-period-cohort (BAPC) predictive model results revealed a U-shaped trend in the IS mortality rates, and with changes in the population structure, the overall mortality from ischemic stroke is expected to increase significantly, particularly in the elderly population.