The alarming rise in stroke cases, related deaths, and health losses worldwide from 1990 to 2021 has cast a stark spotlight on the global healthcare system’s failures in tackling preventable conditions. A new study from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD), presented at the World Stroke Congress 2024, underscores the grim reality: stroke-related deaths have surged by 44%, while the incidence of new strokes has risen by 70%, creating a healthcare crisis that demands urgent attention.

Strokes are now the world's third largest cause of mortality, surpassing even COVID-19, and the cost falls disproportionately on low- and middle-income countries. The study emphasises that stroke is extremely preventable, with 23 modifiable risk factors accounting for 84% of the 2021 stroke burden, including high blood pressure, smoking, excess body weight, and, most notably, air pollution. "The global growth in the number of people who develop stroke, die from it, or remain disabled by stroke is growing fast," cautioned Professor Valery Feigin, lead author of the study at Auckland University of Technology. "This strongly suggests that current stroke prevention strategies are not sufficiently effective."

The study found that metabolic and environmental risk factors are driving the stroke crisis. While high blood pressure and obesity are the key causes, the study also found a 72% increase in stroke risk associated with high temperatures, highlighting the expanding influence of climate change on global health. Air pollution, formerly thought to be a minor risk, is now the leading cause of subarachnoid haemorrhage (a fatal brain bleed), second only to smoking.

Regions with poorly regulated risk factors, such as Sub-Saharan Africa and Southeast Asia. In 2021, stroke incidence and death rates in these places were up to ten times higher than in high-income nations such as North America. Strikingly, hemorrhagic strokes, which result in increased mortality, continue to be a prominent cause of disability, particularly in low- and middle-income countries.

The report argues that global health authorities must act quickly. The stagnation in age-standardized stroke rates since 2015 suggests a concerning trend. Southeast Asia, Oceania, and younger populations are particularly vulnerable, with obesity, high blood sugar, and metabolic disorders becoming more prevalent among young individuals. Dr. Catherine O. Johnson, a co-author from the Institute for Health Metrics and Evaluation, underscored that unless we implement effective preventive strategies urgently, the shift in stroke burden towards younger populations is likely to persist.

In many ways, the current stroke crisis represents both a problem and an opportunity. According to Dr. Johnson, "with 84% of the stroke burden linked to modifiable risk factors, there are tremendous opportunities to alter the trajectory of stroke risk for the next generation." According to the paper, lowering air pollution and implementing evidence-based prevention initiatives can help to control the expanding stroke epidemic.

However, the solutions must be both durable and accessible. Global health organisations advocate for widespread implementation of efficient stroke surveillance, preventive, acute care, and rehabilitation initiatives. According to the GBD report, some high-income regions have made strides in decreasing dietary hazards and smoking. However, the data show that task-shifting—giving nurses and healthcare staff additional responsibilities—along with mobile health platforms—could dramatically close the disparities in LMICs.

"Additional and more effective stroke prevention strategies with an emphasis on population-wide measures must be urgently implemented across all countries," Prof. Feigin said. By leveraging technology like mobile health platforms and artificial intelligence, along with reducing risk factors like air pollution and obesity, we aim to greatly reduce the stroke burden and improve global health outcomes for millions.

The message is clear as world leaders gather in Abu Dhabi for the World Stroke Congress: while the stroke burden is rising, we can still turn the tide with coordinated action on risk factors and environmental issues. The potential to minimise unnecessary deaths and disabilities is enormous, but it demands immediate action from governments, health professionals, and communities alike.