Objective  To investigate the inequality of the disease burden of ischemic stroke in regions with different levels of socio-economic development globally from 1990 to 2021, and to analyze its changing trend.

Methods  Based on the data from the 2021 Global Burden of Disease Study, the correlation between the age-standardized disability-adjusted life years (DALYs) rate of ischemic stroke and the socio-demographic index (SDI) was analyzed. The slope index of inequality (SII) and the concentration index (CI) were used to assess the inequality of the age-standardized DALYs rate and its dynamic changes from 1990 to 2021, as well as the inequality and dynamic changes of the age-standardized DALYs rate of ischemic stroke attributable to specific risk factors.

Results  In 2021, the age-standardized DALY rate of ischemic stroke was 837.36 per 100,000, which was significantly negatively correlated with the SDI level (r=-0.44, P<0.001). From 1990 to 2021, the global age-standardized DALY rate showed a downward trend [AAPC=-1.37, 95%CI (-1.40, -1.33)]. The SII of global ischemic stroke decreased from -212.45[95%CI (-433.72, 8.81)] to -758.54 [95%CI (-920.64, -596.45)], and the CI decreased from 0.03[95%CI (-0.01, 0.06)] to -0.06[95%CI (-0.09, -0.01)], indicating that the degree of inequality increased and the disease burden distribution tilted towards regions with lower SDI levels. The disease burden attributable to traditional risk factors such as hypertension [AAPC=-1.35, 95%CI (-1.38, -1.32)], hypercholesterolemia [AAPC=-1.47, 95%CI (-1.50, -1.44)], high sodium diet [AAPC= -1.16, 95%CI (-1.19, -1.12)] and smoking [AAPC=-1.60, 95%CI (-1.65, -1.56)] decreased. The equity analysis showed that the absolute inequality of most risk factors (such as hypertension, hypercholesterolemia, high fasting blood glucose) worsened and the disease burden shifted towards regions with lower SDI, while relative inequality showed a divergent trend.

Conclusion  From 1990 to 2021, the global disease burden of ischemic stroke showed a downward trend, but there was a significant social inequality, with the burden mainly concentrated in countries with low socio-economic development levels. This indicates that it is necessary to further optimize the global allocation of medical resources, especially to strengthen support for developing countries, to alleviate the current unequal situation of the disease burden of ischemic stroke.

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