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(14825548600)Ganesh R. (14825548600)NaikNaik, Gurudatta (56020694000)Gurudatta (56020694000)NaikNaimzada, Mukhammad David (57209744761)Mukhammad David (57209744761)NaimzadaNair, Sanjeev (7402726229)Sanjeev (7402726229)NairNair, Tapas Sadasivan (59496484400)Tapas Sadasivan (59496484400)NairNajdaghi, Soroush (57218267592)Soroush (57218267592)NajdaghiNajmuldeen, Hastyar Hama Rashid (55485512800)Hastyar Hama Rashid (55485512800)NajmuldeenAnsari, Noureddin Nakhostin (14015121200)Noureddin Nakhostin (14015121200)AnsariNangia, Vinay (57201490837)Vinay (57201490837)NangiaSwamy, Sreenivas Narasimha (57222706843)Sreenivas Narasimha (57222706843)SwamyNargus, Shumaila (58491929300)Shumaila (58491929300)NargusDavani, Delaram Narimani (57934653600)Delaram Narimani (57934653600)DavaniNascimento, Bruno Ramos (14424406800)Bruno Ramos (14424406800)NascimentoNascimento, Gustavo G. (55849893800)Gustavo G. (55849893800)NascimentoNasrollahizadeh, Ali (57483658500)Ali (57483658500)NasrollahizadehNasrollahizadeh, Amir (57223368731)Amir (57223368731)NasrollahizadehNatto, Zuhair S. (37000768500)Zuhair S. (37000768500)NattoNauman, Javaid (35334911400)Javaid (35334911400)NaumanNavaratna, Samidi Nirasha Kumari (56382542100)Samidi Nirasha Kumari (56382542100)NavaratnaNayak, Biswa Prakash (56639942500)Biswa Prakash (56639942500)NayakNayak, Vinod C. (24385399000)Vinod C. (24385399000)NayakNazri-Panjaki, Athare (57207856777)Athare (57207856777)Nazri-PanjakiNdejjo, Rawlance (56586121600)Rawlance (56586121600)NdejjoNegoi, Ionut (57200640014)Ionut (57200640014)NegoiNegoi, Ruxandra Irina (55566106200)Ruxandra Irina (55566106200)NegoiNejadghaderi, Seyed Aria (57218948511)Seyed Aria (57218948511)NejadghaderiNejjari, Chakib (6602168304)Chakib (6602168304)NejjariNematollahi, Mohammad Hadi (56719382000)Mohammad Hadi (56719382000)NematollahiNepal, Samata (56549676600)Samata (56549676600)NepalNewton, Charles Richard James (58921905700)Charles Richard James (58921905700)NewtonNguyen, Dang H. (57220970272)Dang H. (57220970272)NguyenNguyen, Duc Hoang (58693553700)Duc Hoang (58693553700)NguyenNguyen, Hau Thi Hien (58492170200)Hau Thi Hien (58492170200)NguyenNguyen, Hien Quang (58191956000)Hien Quang (58191956000)NguyenNguyen, Nhien Ngoc Y. (59126827800)Nhien Ngoc Y. 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(57204873792)NnajiNnyanzi, Lawrence Achilles (57190763438)Lawrence Achilles (57190763438)NnyanziNomura, Shuhei (55632290700)Shuhei (55632290700)NomuraNoor, Syed Toukir Ahmed (57999331500)Syed Toukir Ahmed (57999331500)NoorNorrving, Bo (12792377500)Bo (12792377500)NorrvingNawsherwan, Nawsherwan (57455256100)Nawsherwan (57455256100)NawsherwanNoubiap, Jean Jacques (55490374000)Jean Jacques (55490374000)NoubiapNri-Ezedi, Chisom Adaobi (57218593582)Chisom Adaobi (57218593582)Nri-EzediNtaios, George (16426036800)George (16426036800)NtaiosNtsekhe, Mpiko (11340073300)Mpiko (11340073300)NtsekheNugen, Fred (57881566200)Fred (57881566200)NugenNurchis, Mario Cesare (57217161453)Mario Cesare (57217161453)NurchisNurrika, Dieta (57204936262)Dieta (57204936262)NurrikaNzoputam, Chimezie Igwegbe (57217058740)Chimezie Igwegbe (57217058740)NzoputamNzoputam, Ogochukwu Janet (57819279400)Ogochukwu Janet (57819279400)NzoputamOancea, Bogdan (26658614800)Bogdan (26658614800)OanceaObamiro, Kehinde O. (57190161875)Kehinde O. (57190161875)ObamiroOdetokun, Ismail A. (58518431400)Ismail A. (58518431400)OdetokunO'Donnell, Martin James (57210591242)Martin James (57210591242)O'DonnellOguta, James Odhiambo (57218948901)James Odhiambo (57218948901)OgutaOh, In-Hwan (57204090669)In-Hwan (57204090669)OhOjo-Akosile, Tolulope R. (58566223700)Tolulope R. (58566223700)Ojo-AkosileOkati-Aliabad, Hassan (57211186862)Hassan (57211186862)Okati-AliabadOkeke, Sylvester Reuben (57200939187)Sylvester Reuben (57200939187)OkekeOkekunle, Akinkunmi Paul (56668691000)Akinkunmi Paul (56668691000)OkekunleOkidi, Lawrence (57204436749)Lawrence (57204436749)OkidiOkonji, Osaretin Christabel (57222864302)Osaretin Christabel (57222864302)OkonjiOladnabi, Morteza (54790070100)Morteza (54790070100)OladnabiOlagunju, Andrew T. (26029995700)Andrew T. (26029995700)OlagunjuOlaiya, Muideen Tunbosun (55889996900)Muideen Tunbosun (55889996900)OlaiyaOlalusi, Oladotun Victor (57967355600)Oladotun Victor (57967355600)OlalusiOlasehinde, Tosin Abiola (56088263100)Tosin Abiola (56088263100)OlasehindeOlasupo, Omotola O. (57204397262)Omotola O. (57204397262)OlasupoOlatubi, Matthew Idowu (57200278115)Matthew Idowu (57200278115)OlatubiOliveira, Arão Belitardo (57202259367)Arão Belitardo (57202259367)OliveiraOliveira, Gláucia Maria Moraes (6505822894)Gláucia Maria Moraes (6505822894)OliveiraOlorukooba, Abdulhakeem Abayomi (57211516423)Abdulhakeem Abayomi (57211516423)OlorukoobaOlufadewa, Isaac Iyinoluwa (57216286071)Isaac Iyinoluwa (57216286071)OlufadewaOluwafemi, Yinka Doris Doris (57215413986)Yinka Doris Doris (57215413986)OluwafemiOluwatunase, Gideon Olamilekan (58956741600)Gideon Olamilekan (58956741600)OluwatunaseOmar, Hany A. (35213612000)Hany A. (35213612000)OmarBali, Ahmed Omar (57201273344)Ahmed Omar (57201273344)BaliO'Neil, Adrienne E. (57253614600)Adrienne E. (57253614600)O'NeilOng, Sok King (36614524300)Sok King (36614524300)OngOnwujekwe, Obinna E. (7003992855)Obinna E. (7003992855)OnwujekweOpejin, Abdulahi Opejin (59129819200)Abdulahi Opejin (59129819200)OpejinOrdak, Michal (55992015900)Michal (55992015900)OrdakOrnello, Raffaele (55865973700)Raffaele (55865973700)OrnelloOrtega-Altamirano, Doris V. (6505938824)Doris V. (6505938824)Ortega-AltamiranoOrtiz, Alberto (57222069015)Alberto (57222069015)OrtizOrtiz-Prado, Esteban (56037076100)Esteban (56037076100)Ortiz-PradoOsman, Wael M.S. (57195344402)Wael M.S. (57195344402)OsmanOsuagwu, Uchechukwu Levi (46062324800)Uchechukwu Levi (46062324800)OsuagwuOtstavnov, Stanislav S. (57204561394)Stanislav S. (57204561394)OtstavnovOwolabi, Mayowa O. (57222581892)Mayowa O. (57222581892)OwolabiOyeyemi, Ifeoluwa Temitayo (55928776800)Ifeoluwa Temitayo (55928776800)OyeyemiOzair, Ahmad (57215601638)Ahmad (57215601638)OzairPadukudru, Mahesh P.A. (57195664371)Mahesh P.A. (57195664371)PadukudruPacheco-Barrios, Kevin (57201981698)Kevin (57201981698)Pacheco-BarriosPadron-Monedero, Alicia (56532107100)Alicia (56532107100)Padron-MonederoPadubidri, Jagadish Rao (58295062300)Jagadish Rao (58295062300)PadubidriPalicz, Tamás (57218865382)Tamás (57218865382)PaliczPalma-Alvarez, Raul Felipe (57028413200)Raul Felipe (57028413200)Palma-AlvarezPan, Feng (57220873446)Feng (57220873446)PanPanda-Jonas, Songhomitra (6603112353)Songhomitra (6603112353)Panda-JonasKatare, Deepshikha Pande (54399844200)Deepshikha Pande (54399844200)KatarePandey, Anamika (55633420800)Anamika (55633420800)PandeyPandey, Ashok (57210886573)Ashok (57210886573)PandeyPandi-Perumal, Seithikurippu R. (7801638271)Seithikurippu R. (7801638271)Pandi-PerumalPanos, Leonidas D. (57204439372)Leonidas D. (57204439372)Panos2025-06-122025-06-122024https://doi.org/10.1016/S1474-4422(24)00369-7https://www.scopus.com/inward/record.uri?eid=2-s2.0-85203982941&doi=10.1016%2fS1474-4422%2824%2900369-7&partnerID=40&md5=1ac5885c3a4906232212d618507ede46https://remedy.med.bg.ac.rs/handle/123456789/888Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license