Global Stroke Burden Keeps Rising Despite Falling Stroke Rates

New study shows prevention strategies aimed only at "high-risk" individuals are not enough to reverse the trend.

SWITZERLAND, October 28, 2026 /EINPresswire.com/ -- A new Global Burden of Disease (GBD) study in Neuroepidemiology looks closely at a striking contradiction in global stroke prevention: even as age-standardized stroke rates have fallen substantially over the past three decades, the number of people suffering and dying from stroke continues to rise.
Researchers led by Professor Valery L. Feigin of Auckland University of Technology estimate that in 2023, 13.2 million people experienced a new stroke, 6.8 million died, and almost 105 million were living with the effects of a previous stroke. Stroke remained the world's second leading cause of death and third leading cause of death and disability combined.

Between 1990 and 2023, age-standardized stroke mortality fell by 52%, disability-adjusted life year (DALY — a measure combining years of life lost to early death and years lived with disability) rates by 48%, and incidence by 25%. Yet over the same period, the absolute number of new strokes rose by 73%, deaths by 22%, and DALYs by 18%.

Population growth and aging explain part of the increase, but not all of it, said Feigin. "Stroke used to be called a disease of the elderly. That's no longer correct: 52% of strokes now happen in people of working age, under 70."

An estimated 1.9 million strokes now occur annually in people aged 15–49, a rise Feigin and his colleagues attribute to earlier, heavier exposure to metabolic risk factors, particularly poorly controlled blood pressure and childhood obesity trends now surfacing as adult hypertension and diabetes.
Uncontrolled hypertension remains the single largest driver of stroke worldwide, accounting for roughly 60% of the global burden. Yet about half of people prescribed blood-pressure medication stop taking it within months, often once their readings normalize, and only around 20% of people can feel the physical effects of elevated blood pressure. Feigin calls it "a silent killer"; many people don't know anything is wrong until they have a stroke or heart attack.
High ambient temperature is also emerging as a major, underappreciated contributor: its share of the stroke burden rose 122% between 1990 and 2023, accounting for more than 2.2 million DALYs in 2023 alone, concentrated in North and Central Africa, the Middle East, and South Asia. Low temperature carries risk too, Feigin noted, particularly in regions historically accustomed to warmth, where cold snaps are now linked to higher rates of stroke and heart attack.

Feigin argues the field has leaned too heavily on a "high-risk" prevention strategy, screening people and treating only those found to be at elevated cardiovascular risk.

"Even in a best-case scenario, treating high-risk individuals only prevents around 11% of strokes and heart attacks, because roughly 80% of strokes occur in people classified as low or moderate risk," he said. Recent reviews of randomized controlled trials, he added, found that risk screening alone, without follow-up action, produces no meaningful reduction in events.

Instead, he favors pairing population-wide measures, including salt reduction, taxes on sugary drinks, and tobacco control, with individual prevention through digital tools like smartphone risk-assessment apps, which can reach people at any level of risk.
"We need a strategy that treats everyone with even one elevated risk factor, not just those who cross a high-risk threshold. Otherwise, we are heading toward a crisis health systems will struggle to absorb," he said.

Global inequalities remain stark: more than 80% of stroke deaths and DALYs occur in low- and middle-income countries, where rising exposure to risk factors — not population aging — is the dominant driver of increasing stroke numbers.
The Latest Global Stroke Fact Sheet 1990–2023: Global Burden of Disease Study was published in Neuroepidemiology on 7 May 2026. DOI: 10.1159/000552065.

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