Persistent global inequality in eye injury burden: a secondary analysis of the 2021 global burden of disease study (1990-2021).

To assess health inequities associated with retinoblastoma across various Socio-Demographic Index (SDI) regions and evaluate whether these inequities have decreased from 1990 to 2021, with the aim of enhancing awareness and guiding government policies. Population-based demographic analysis. Children diagnosed with retinoblastoma from 204 countries and territories. The estimates and their 95% uncertainty interval (UI) for disability-adjusted life-years (DALYs) of retinoblastoma were extracted from Global Burden of Disease study (GBD) 2021. The age-standardized DALYs and the average annual percentage change (AAPC) were evaluated. The Slope Index of Inequality (SII) and concentration index were computed to quantify the absolute and relative cross-national health inequality. All SDI regions and the majority of countries experienced a significant decline in age-standardized DALYs from 1990 to 2021. The decrease was more rapid in middle to high SDI regions than in low to low-middle SDI regions. Globally, the 2-4 years age group had the highest DALYs rate, consistent with trends in low to middle SDI regions. In contrast, the highest DALYs rate in high and high-middle SDI regions was found in the 12-23 months age group. The SII was -40.81 (95% CI -36.04 to -45.58) DALYs per 100,000 population in 1990 and - 30.32 (95% CI -27.18 to -33.47) DALYs per 100,000 population in 2021. The concentration index increased from -0.37 (95% CI -0.46 to -0.28) in 1990 to -0.45 (95% CI -0.53 to -0.36) in 2021, although this increase did not reach statistical significance (p = 0.256). Despite advancements in retinoblastoma management, the overall burden of the disease-related DALY remains disproportionately concentrated in poorer populations. The health inequalities are persisting and widening. This underscores the limitations of current efforts. Until progress benefits everyone, the vision of equitable healthcare remains imperfect.

Background:Low back pain (LBP) has become a major public health problem worldwide although the burden and underlying causes differ across locations and demographic groups.Objectives:To report the distribution, trend and risk factor in the burden of LBP from the Global Burden of Disease Study 2019 (GBD 2019).Methods:Based on GBD 2019, decomposition analyses were performed according to gender, age, geography and sociodemographic index (SDI). The number and age standardized rate of incidence, prevalence and disability adjusted life years (DALYs) with 95% uncertainty intervals (UI) were calculated.Results:In 2019, female patients have a slightly higher number of prevalence (17%), incidence (15%) and DALYs (16%) than male patients. Out of twenty 5-year age group, the number of incidences, prevalence, DALYs peak at 50-54 age group, while the rate of incidence, prevalence, DALYs peaked at 80-84 age group. From 5 SDI regions, the highest number and age-standardized rate of incidence, prevalence, DALYs were observed in middle and high SDI region, respectively. Considering 21 GBD regions, the highest number of incidence, prevalence, and DALYs were observed in East Asia, while the highest age standardized rate of incidence, prevalence and DALYs all found in Central Europe, High-income North America, High-income North America, respectively. In 204 countries and territories, the top 3 highest number of incidence, prevalence and DALYs were from China, India, United States of America. The top 3 highest age-standardized rate of prevalence, and DALYs were Georgia, United States of America, Denmark, while top 3 highest age-standardized rate of incidence were Poland, Vanuatu, Romania.From 1990 to 2019, globally, the number of incidence, prevalence, DALYs increased by 50%, 47%, 47% to 223,738,363 (95%UI 197,935,799-253,300,243), 569,089,727 (95% UI 505,632,980-641,256,710), 63,533,528 (95%UI 44,883,714-84,975,210), while age standardized rate of incidence, prevalence and DALYs decreased by 13%, 16%, 16% to 2,750 (95%UI 2,427-3,108), 6,974 (95%UI 6,192-7,862), 778 (95%UI 548-1,043). In 5 SDI regions, low SDI region has the highest percentage increases in number of incidence, prevalence and DALYs, the highest percentage decrease in age standardized rate of incidence, prevalence and DALYs were observed in High-middle SDI. In 21 GBD regions, the highest percentage increase in number of incidence, prevalence and DALYs were found in Central Sub-Saharan Africa, while East Asia has the highest percentage decrease in age standardized rate of incidence, prevalence and DALYs. In 204 countries and territories, the greatest percentage increase in number rate of incidence, prevalence, and DALYs were observed in Qatar, while the greatest percentage decrease in age-standardized rate of incidence, prevalence, and DALYs were found in China.In 2019, three risk factors account for 40% (95%UI:36%, 40%) DALYs due to LBP, including smoking (16%, 95%UI:12%, 20%), high body-mass index (7%,95%UI: 4%, 10%), occupational ergonomic factors (24%, 95%UI:22%, 26%).Conclusion:There is significant varied and increased disease burden of LBP by gender, age and geography, partly due to population growth and ageing. The age-standardized rate of prevalence, incidence and DALYs are decreasing, especially in countries such as China and India. Cost effective interventions targeted risk factors are required to minimize the ongoing burden of this condition.

Maternal hypertensive disorders (MHD) remain a significant global health challenge. This study aims to provide a comprehensive analysis of the global burden of MHD from 1990 to 2021, focusing on incidence and mortality trends across different sociodemographic index (SDI) regions and age groups. We utilized Global Burden of Disease (GBD) study methodologies to analyze MHD incidence and mortality. Temporal trends were examined using Joinpoint regression to calculate annual percentage changes and average annual percentage changes with 95% confidence interval (CI). Age-period-cohort models were applied to analyze trends across different age groups, time periods, and birth cohorts, with particular attention to SDI regions. Globally, the age-standardized incidence rate (ASIR) of MHD decreased from 554.35 (95% Uncertainty Interval [UI]: 461.38t o 675.43) per 100,000 in 1990 to 461.94 (95% UI: 392.73 to 551.65) in 2021, with an average annual percent change (AAPC) of − 0.6% (95% CI: −0.67% to − 0.53%). The age-standardized death rate (ASDR) declined from 1.94 (95% UI: 1.71–2.15) per 100,000 in 1990 to 0.97 (95% UI: 0.81–1.18) in 2021 (AAPC − 2.18%; 95% CI: −2.3% to − 2.06%). Low SDI regions faced the highest burden. Age-period-cohort analyses revealed heterogeneous trends across age groups and SDI regions, with younger age groups (particularly ages 15–19 years) showing the most substantial improvements, demonstrated by the steepest declines in both incidence (-1.62% per year) and mortality rates (-2.57% per year). More recent birth cohorts demonstrated greater improvements, with declining risks of both incidence and mortality compared to earlier birth cohorts. Despite global reductions in MHD incidence and mortality over the past three decades, substantial disparities persist across regions and age groups. Targeted interventions, particularly in low SDI regions and among high-risk age groups, are crucial for further reducing the global burden of MHD.

BackgroundColorectal cancer (CRC) is among the leading causes of cancer-related mortality worldwide. This study aimed to assess the global burden of CRC across 204 countries and territories from 1990 to 2021, and identify its attributable risk factors.MethodsEstimates of CRC incidence, mortality, and disability-adjusted life years (DALYs) were derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, stratified by age, sex, and geographical region over the 1990–2021 period. Additionally, DALYs attributable to risk factors with established causal links to CRC were calculated.Results100,000 population (95% uncertainty interval [UI]: 25.36–29.90), mortality rate 13.23 per 100,000 (95% UI: 12.04–14.19), and DALY rate 309.21 per 100,000 (95% UI: 287.52–331.52). The number of new CRC cases increased from 916,583 in 1990 to 2,194,143 in 2021. The age-standardized incidence rate (ASIR) rose from 24.0 to 25.6 per 100,000. High SDI (Socio-demographic Index) regions had the highest ASIR (40.5 per 100,000 in 2021), while low SDI regions had the lowest (7.4 per 100,000 in 2021). Between 1990 and 2021, the global age-standardized mortality rate (ASDR) decreased from 15.6 to 12.4 per 100,000, and the age-standardized DALY rate declined from 357.3 to 283.2 per 100,000. However, this reduction was uneven across SDI regions. Key risk factors included behavioral and metabolic factors, among which a diet low in whole grains significantly increased CRC incidence.ConclusionFrom 1990 to 2021, the global CRC burden increased significantly, with notable variations across SDI regions. While high SDI regions made progress in reducing mortality and DALYs, low SDI regions now face a heavier burden. Targeted interventions for modifiable risk factors and improved healthcare access in less developed regions are essential to mitigate the global impact of CRC.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

BackgroundThe distribution of diet-attributable cancer burden has not been systematically analyzed globally. This study aimed to analyze the diet-attributable cancer burden using the Global Burden of Disease (GBD) database to provide insights into reducing the dietary risk-related cancer burden across regions with different development levels.MethodsData on cancer deaths and disability-adjusted life years (DALYs) attributable to diet were downloaded from the GBD database (1990–2021). The cancer burden attributable to nine dietary factors and total dietary factors was sorted, and Joinpoint regression analysis was performed according to the Socio-Demographic Index (SDI) regions. Then, using the DALYs data, a health inequality analysis was conducted, and the Slope Index of Inequality (SII) and concentration indices (CI) for 1990 and 2021 were calculated.ResultsFrom 1990 to 2021, the global cancer burden attributed to diet decreased continuously, with an average annual percentage change (AAPC) of -1.40 (-1.48, -1.32) for mortality (P < 0.01) and an AAPC of -1.49 (-1.57, -1.42) for DALYs (P < 0.01). Colon and rectal cancers were the most influenced by dietary factors, with diet-attributable deaths comprising 71.70% and 68.14% of total deaths in 1990 and 2021, respectively, followed by breast and stomach cancers, which both exceeded 40% in both years. The diet-related cancer burden decreased rapidly in the high and high-middle SDI regions with AAPCs for both mortality and DALYs being less than 0 (P < 0.01). In contrast, there was Little improvement in the low- and low-middle SDI regions. In 2021, the absolute values of the SII (296.72) and CI (-0.17) attributed to global dietary risks were higher than those in 1990 with the SII of 267.61 and CI of -0.17.ConclusionDietary factors continued to be a significant risk factor for cancer in 2021. High red meat consumption, low intake of whole grains, and low milk intake were the three primary dietary risks.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24570-7.

Backgroud Non-Hodgkin lymphoma (NHL) is a common B/NK/T cell lymphoma. We collected detailed data about the incidence and mortality of NHL from Global Burden of Disease (GBD) Study in 2017 and extensively assessed the disease burden of NHL at the global level and also analysed its current trends according to sex, age, socio-demographic index (SDI), country and region. Methods By obtaining relevant data from Global Burden of Disease Study in 2017, estimated annual percentage changes (EAPCs) of age-standardized rate (ASR) were calculated to assess the current trends of the rate of incidence and mortality. Results Globally, ASR of incidence in NHL was increased while ASR of mortality and its annual percentage change was relatively stable. EAPCs in the incidence of NHL decreased in the low SDI regions but increased in the high SDI regions. The ratio of male to female mortalities was the highest in the 50–69-year-old age group, especially in the middle and middle-high SDI regions. Conclusion The incidence of NHL was increased globally, whereas the deaths and its annual percentage change were relatively stable from 1990 to 2017. Key messages Age-standardized rate (ASR) of incidence in NHL was increased globally from 1990 to 2017. ASR of mortality and its annual percentage change in NHL were relatively stable globally from 1990 to 2017. Estimated annual percentage changes (EAPCs) in the incidence of NHL decreased in the low socio-demographic index (SDI) regions but increased in the high SDI regions.

To describe the trend of changes in the disease burden of age-related hearing loss in China and globally from 1990 to 2021, to forecast the prevalence and years lived with disability (YLD) rates of age-related hearing loss from 2022 to 2036, and to provide a reference for the prevention and control of the disease burden associated with age-related hearing loss. Using the Global Burden of Disease 2021 (GBD2021) data, this study selected age-standardized prevalence rate (ASPR) and YLD as indicators. The disease burden and long-term trends of age-related hearing loss in China and globally from 1990 to 2021 were described by different socio-demographic index (SDI) and gender. Joinpoint regression was used to calculate the average annual percent change (AAPC) to assess the trend changes in the disease burden. Decomposition analysis was applied to explore the relative impacts of aging, population growth, and epidemiological changes on the variation in disease burden. An autoregressive integrated moving average (ARIMA) model was used to forecast the age-standardized pre-valence rate and YLD rates from 2022 to 2036. The prevalence of age-related hearing loss in China in 2021 was 82 162.49 (73 288.08-89 187.21) per 100 000, higher than the global SDI level of 66 238.16 (59 982.54-72 669.82) per 100 000, the high SDI region ' s level of 57 650.42 (52 059.12-63 889.02) per 100 000, the upper-middle SDI region ' s level of 69 115.59 (62 494.18- 75 340.64) per 100 000, the middle SDI region ' s level of 72 365.56 (65 181.43-78 912.01) per 100 000, the lower-middle SDI region ' s level of 64 439.66 (58 368.22-71 468.27) per 100 000, and the low SDI region ' s level of 61 725.25 (55 749.18-68 477.67) per 100 000. The age- related hearing loss YLD rate in China was 2 762.98 [95% uncertainty interval (UI): 1 855.28-3 880.68] per 100 000, higher than the global SDI level of 2 236.75 (95%UI: 1 511.56-3 155.88) per 100 000, the high SDI region ' s level of 1 805.79 (95%UI: 1 212.69-2 577.17) per 100 000, the upper-middle SDI region ' s level of 2 316.58 (95%UI: 1 557.53-3 274.87) per 100 000, the middle SDI region ' s level of 2 480.99 (95%UI: 1 678.17-3 489.24) per 100 000, the lower-middle SDI region ' s level of 2 313.28 (95%UI: 1 578.35-3 271.50) per 100 000, and the low SDI region ' s level of 2 383.55 (95%UI: 1 623.66-3 365.68) per 100 000. From 1990 to 2021, both the prevalence and YLD rate of age-related hearing loss in China showed an increasing trend, rising by an average of 0.18% (95%CI: 0.16%-0.19%) and 0.29% (95%CI: 0.27%-0.30%) per year, respectively. The rates of increase in prevalence were the same for both men and women, with men showing a 0.18% increase (95%CI: 0.17%-0.19%, P < 0.001) and women showing a 0.18% increase (95%CI: 0.16%-0.19%, P < 0.001). However, the YLD rate increase was faster in men than in women, with men experiencing a 0.32% increase (95%CI: 0.27%-0.37%, P < 0.001) and women experiencing a 0.27% increase (95%CI: 0.26%-0.28%, P < 0.001). Decomposition analysis showed that population growth was the main factor driving the increase in prevalence and YLD rate globally and across different SDI regions. However, aging was the primary factor contributing to the increase in prevalence and YLD rate in China. ARIMA model predictions suggested that the prevalence and YLD rate of age-related hearing loss would continue to rise from 2022 to 2036, with the predicted prevalence and YLD rate in 2036 reaching 89 723.99 per 100 000 and 2 872.47 per 100 000, respectively. The prevalence and disease burden of age-related hearing loss in individuals aged 60 and above in China rank first globally. From 1990 to 2021, both the prevalence and YLD rate of age-related hearing loss have shown a continuous upward trend, consistently surpassing the levels observed in various SDI regions worldwide. The prevalence and disease burden of age-related hearing loss are particularly significant among elderly men. Moreover, projections indicate that the disease burden of age-related hearing loss will continue to rise over the next 15 years. Therefore, it is urgent to pay close attention to age-related hearing loss in this specific population, and early intervention measures are crucial to reduce the disease burden associated with age-related hearing loss.

This study aims to assess the disease burden and care quality along with cross-country inequalities for stroke at global, regional, and national levels from 1990 to 2021. Data on stroke were extracted from the Global Burden of Disease (GBD) study 2021 for the globe, five sociodemographic index (SDI) regions, 21 GBD regions, and 204 countries/territories. The disease burden was quantified using the age-standardized disability-adjusted life years rate (ASDR). Quality of care (QoC) was evaluated through the age-standardized QoC index (QCI). To assess cross-country disparities in both disease burden and age-standardized QCI, the slope index of inequality (SII) and the concentration index were utilized. From 1990 to 2021, the global ASDR of stroke decreased from 3078.95 (95% uncertainty interval [UI]: 2893.58, 3237.34) to 1886.20 (95% UI: 1738.99, 2017.90) per 100,000 population, while the age-standardized QCI improved from 50.79 to 64.61. However, the results of inequalities showed worsening inequalities in both ASDR and QCI, with lower SDI countries shouldering a disproportionate burden and higher SDI countries maintaining higher QoC. The SII and concentration index for ASDR indicated a worsening inequality among lower SDI countries, with SII increasing to -2616.44 and the concentration index increasing to -0.1119 in 2021. Meanwhile, the SII and concentration index for age-standardized QCI showed a worsening inequality among higher SDI countries, with SII of 27.48 and concentration index of 0.0922 in 2021. Despite notable global advancements, significant disparities in stroke still exist, particularly in lower SDI regions facing high disease burdens and substandard care.

BackgroundInflammatory bowel disease (IBD) imposes a substantial burden on governments and healthcare systems. Understanding the global pattern and temporal trends of IBD is crucial for initiating more targeted preventative and...

Temporal trends in the incidence of intracerebral hemorrhage from 1992 to 2021: An age-period-cohort analysis based on the global burden of disease study 2021.

BackgroundLower respiratory infections (LRIs) cause substantial mortality and morbidity. The present study reported and analysed the burden of LRIs in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex, etiology, and socio-demographic index (SDI).MethodsThe data used in this study were sourced from the Global Burden of Disease (GBD) study 2019. The annual incidence, deaths, and disability-adjusted life-years (DALYs) due to LRIs were presented as counts and age-standardised rates per 100,000 population, along with their 95% uncertainty intervals (UIs). The average annual percent changes (AAPC) in the age-standardised incidence, death and DALYs rates were calculated using Joinpoint software and correlations (Pearson’s correlation coefficient) between the AAPCs and SDIs were calculated using Stata software.ResultsIn 2019, there were 34.1 million (95% UI 31.7–36.8) incident cases of LRIs in MENA, with an age-standardised rate of 6510.2 (95% UI 6063.6–6997.8) per 100,000 population. The number of regional DALYs was 4.7 million (95% UI 3.9–5.4), with an age-standardised rate of 888.5 (95% UI 761.1–1019.9) per 100,000 population, which has decreased since 1990. Furthermore, Egypt [8150.8 (95% UI 7535.8–8783.5)] and Afghanistan [61.9 (95% UI 52.1–72.6)] had the highest age-standardised incidence and death rates, respectively. In 2019, the regional incidence and DALY rates were highest in the 1–4 age group, in both females and males. In terms of deaths, pneumococcus and H. influenza type B were the most and least common types of LRIs, respectively. From 1990 to 2019, the burden of LRIs generally decreased with increasing SDI. There were significant positive correlations between SDI and the AAPCs for the age-standardised incidence, death and DALY rates (p < 0.05). Over the 1990–2019 period, the regional incidence, deaths and DALYs attributable to LRIs decreased with AAPCs of − 1.19% (− 1.25 to − 1.13), − 2.47% (− 2.65 to − 2.28) and − 4.21% (− 4.43 to − 3.99), respectively.ConclusionsThe LRI-associated burden in the MENA region decreased between 1990 and 2019. SDI had a significant positive correlation with the AAPC and pneumococcus was the most common underlying cause of LRIs. Afghanistan, Yemen and Egypt had the largest burdens in 2019. Further studies are needed to investigate the effectiveness of healthcare interventions and programs to control LRIs and their risk factors.

ObjectiveTo comprehensively evaluate the epidemiological burden, temporal trends, socio-demographic inequalities, and long-term forecasting of fall-related injuries in older adults (aged ≥ 55 years) through systematic analysis of the Global Burden of Disease (GBD) 2021 dataset.MethodsWe extracted data on fall-related incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for adults aged ≥ 55 from the GBD database (1990–2021). Temporal trends were assessed using estimated annual percentage changes (EAPCs) and joinpoint regression. Age-period-cohort modeling was applied to disentangle the effects of age, time period, and birth cohort. Socioeconomic inequalities were evaluated using the slope index of inequality and concentration index. Future projections to 2046 were generated via Bayesian Age-Period-Cohort analysis.ResultsBetween 1990 and 2021, the absolute number of fall-related incidence, deaths, and DALYs among older adults doubled globally. While age-standardized rates remained relatively stable, distinct patterns emerged across Socio-demographic Index (SDI) regions: high SDI regions had the highest incidence and prevalence, whereas low SDI regions experienced higher mortality. Joinpoint regression identified sex-specific acceleration phases, notably 2005–2021 for incidence (APC = 3.747), with women demonstrating higher ASIR but men showing elevated ASPR/ASDR. Significant socioeconomic inequalities were observed and have widened over time. Projections indicate a continued increase in the absolute burden of falls through 2046, despite stable or declining age-standardized rates.ConclusionsFalls represent a major and growing public health challenge among older adults worldwide, with pronounced disparities across sex and socioeconomic levels. There is an urgent need for targeted prevention strategies and enhanced resource allocation—particularly in low SDI settings—to reduce the health impact of falls in aging populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25016-w.

BackgroundLate-life depression (LLD) stands as a prevalent mental health issue among older adults, frequently intertwined with cardiovascular and cerebrovascular diseases as well as cognitive decline. The occurrence of LLD in the older adults, who often present with multiple aging-related conditions, frequently results in this disorder being overlooked. However, the astronomical treatment costs and the considerable societal burden associated with LLD necessitate urgent and sustained attention.Materials and methodsUtilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we extracted incidence rates and disability-adjusted life years (DALYs) of LLD in individuals aged 60 and older. The extracted data underwent rigorous evaluation through the application of age-period-cohort models, the health inequality concentration index, and frontier analysis.ResultsFrom 1990 to 2021, a global increase was observed in both the age-standardized incidence rate (ASIR) and DALY rate of LLD. Specifically, the ASIR ascended by 0.01 per 100,000 annually, while the DALY rate rose by 0.03 per 100,000 each year. Notably, a statistically significant inverse relationship was identified between ASIR and the Socio-demographic Index (SDI) (p < 0.001). Additionally, a notable linear correlation was discerned between age-standardized death rate (ASDR) and SDI, albeit without a discernible downward trend (p < 0.001). According to the SDI, the Estimated average percentage change (EAPC) of five SDI districts showed no increase or decrease. Globally, the incidence of LLD showed an upward trend in the high SDI, middle SDI, and low-middle SDI regions, a downward trend in the high-middle SDI region, and no significant increase or decrease in the low SDI region. In the age-period-cohort analysis, we found that the incidence of LLD increased with age in high and middle SDI regions compared with low SDI regions, and the results were the opposite in low SDI regions, with significant regional characteristics. The period effect analysis revealed that irrespective of gender, the trends in incidence and DALY rates remained relatively unchanged globally from 1992 to 2021. As SDI levels rose, the SDI-adjusted disparities in incidence and DALY rates tended to stabilize. A comparative analysis of data from 1990 to 2021 highlighted a relative decline in health inequalities.ConclusionThis comprehensive assessment of the disease burden of LLD among the global population aged 60 and older underscores significant accomplishments while simultaneously emphasizing areas requiring ongoing vigilance. In the context of relentless population growth and aging, the favorable downturns in incidence and DALY rates reflect tangible advancements in managing LLD.

BackgroundStroke is a major cause of acute neurological symptoms in children with significant long-term neurological sequelae. However, data of diseases burden on stroke among children was lack. We aimed to be dedicated to analyze and compare global trends as well as regional and sociodemographic differences in stroke prevalence, incidence, mortality and disability-adjusted life-years (DALYs) among children aged 0 ~ 14 years.MethodWe obtained data on annual number of incident strokes, prevalent strokes, deaths, and DALYs, age-standardized incidence rates (ASIRs), prevalence rates (ASPRs), mortality rates (ASMRs) and DALY rates (ASDRs) of stroke among individuals aged 14 years and younger during 1990–2019 from the 2019 Global Burden of Disease Study. To quantify the temporal trends, we calculated changes (%) in number, and used joinpoint regression analysis to identify the average annual percentage changes (AAPCs) of age standardized rates.ResultGlobally, the incident strokes and prevalent strokes increased by 18.51% and 31.97%, respectively, but DALYs due to stroke and deaths due to stroke decreased by 60.18% and 65.03%, respectively, from 1990 to 2019. During the same period, ASIR increased by 0.21% (95%CI: 0.17, 0.24) from 18.02 to 100,000 population in 1990 to 19.11 per 100,000 in 2019; ASPR increased by 0.66% (95%CI: 0.36, 0.96) from 68.88 to 100,000 population in 1990 to 81.35 per 100,000 in 2019; while ASMR (AAPC= -3.94; 95%CI: -4.07, -3.81) and ASDR (AAPC= -3.50; 95%CI: -3.64, -3.36) both decreased. In 2019, the highest age standardized incidence, prevalence, mortality, and DALY rates all occurred in low sociodemographic index (SDI) regions. The greatest increase of age standardized incidence rate (AAPC = 0.21; 95%CI: 0.18, 0.25) and prevalence rate (AAPC = 1.15; 95%CI: 0.34, 1.96) both were in high SDI regions. Eastern Sub-Saharan Africa had the highest ASIR and ASPR in 2019, and Oceania had the highest ASMR and ASDR in 2019 across 21 GBD regions. High-income North America had the largest increase in ASIR (AAPC = 0.63; 95%CI: 0.59, 0.66) and ASPR (AAPC = 1.58; 95%CI: 0.54, 2.63). Against the overall decreasing trend of ASMR, an increasing trend of ASMR was found in Zimbabwe (AAPC = 0.91; 95%CI: 0.44, 1.37) and Botswana (AAPC = 0.74; 95%CI: 0.02, 1.47).ConclusionThe overall increasing stroke incidence and prevalence indicated that prevention and management of stroke among younger population should be critical in the future. Despite stroke mortality with falling trend worldwide, specific countries or territories present worrying increase in stroke mortality. Without urgent implementation of effective primary prevention strategies, the stroke burden of children will probably continue to grow across the world, particularly in high-SDI countries.