Global burden of ischemic stroke attributable to high body-mass index in 204 countries and territories, 1990–2019

Abstract Background A high body mass index (hBMI) is one of the major risk factors for ischemic stroke (IS), although independent estimates of the global burden and trend of IS attributable to hBMI are unclear. Methods Study data was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study and analyzed by age, sex, year, and geographical location. The socio-demographic index (SDI) and the human development index (HDI) were used as indicators of national socioeconomic status; Geographic distribution and trend were assessed by calculating the estimated annual percentage change (EAPC); Associations between age-standardized death rate (ASMR) or disability-adjusted life years rate (DALY) and socioeconomic status were analyzed. Results Deaths and DALYs increased worldwide from 1990 to 2019, with increases of 79.18% for the former and 96.03% for the latter; the ASMR and ASDR decreased, with ASMR and ASDR-related EAPCs of -1.06 (95% CI: -1.19–-0.92) and − 0.46 (95% CI: -0.60–-0.35), respectively; Women had a higher number of deaths and DALYs, and the majority of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by Eastern Europe, Central Asia and North Africa and the Middle East; ASMR-related EAPC was associated with ASMR in 1990 (R=-0.36, P < 0.001) and SDI in 2019 in different countries (R=-0.67, P < 0.001), respectively; these patterns were similar to what ASDR had; the HDI in 2019 was associated with ASMR-related EAPC (R=-0.72, P < 0.001) and ASDR-related EAPC in different countries (R= -0.71, P < 0.001). Conclusions The number of deaths and DALY of ischemic stroke attributable to hBMI worldwide had increased substantially from 1990 to 2019. Successful population-wide initiatives targeting hBMI may mitigate a wide range of burdens on this disease. Taking into account variations in SDI burden, future prevention and control strategies must be developed and implemented according to country-specific development status.