Global Ischemic Stroke Burden Due to High BMI, 1990–2021: An Age-Period-Cohort Study and Future Risk Prediction Using GBD Data

Background : In this study, we used Global Burden of Disease (GBD) data to analyze the worldwide burden of ischemic stroke caused by high body mass index (BMI). The objective was to describe the current distribution of the disease burden and predict future trends to support public health organizations and governments of various countries in formulating targeted healthcare policies. Methods : We analyzed crucial disease burden indicators for ischemic stroke caused by high BMI across five Socio-demographic Index (SDI) regions, 21 GBD regions, and 204 countries. These indicators were compared and visualized by age, sex, and SDI. We performed inequality and frontier analyses of disease burden across different SDI regions and used age-period-cohort (APC) analysis to explore the drivers of the disease burden. The Bayesian APC method was applied to predict future trends. Results : Between 1990 and 2021, the number of ischemic stroke deaths and disability-adjusted life years (DALYs) because of high BMI nearly doubled, increasing by 95.7% and 108.8%, respectively. Conversely, the age-standardized mortality rate (ASMR) and age-standardized disability adjusted life year rate(ASDR) declined, with an estimated annual percentage change of −1.103 and −0.583, respectively. Countries with an SDI of approximately 0.7 experienced the greatest burden. Health inequality analysis revealed that the previously observed higher disease burden in high-income areas decreased by 2021. APC analysis revealed a significant increase in risk for birth cohorts after 1980, particularly in individuals aged 20–39. Projections suggest a rise in global ASMR to 2.252 per 100,000 by 2036, with a more pronounced increase among males. Conclusions : Between 1990 and 2021, deaths and DALYs from ischemic stroke caused by high BMI increased substantially. In terms of economic development, the disease burden has shifted, with ASMR and ASDR rising in low- and middle-income areas. From the perspective of population characteristics, the disease burden among young people has been increasing annually; however, 65-year-old women bear a heavier disease burden than men do. These findings are a crucial warning to public health management departments worldwide, highlighting the need for targeted policies to address the growing impact of high BMI on ischemic stroke.