A global analysis of pediatric stroke burden from 1990 to 2021 has found that while overall deaths and disability-adjusted life years (DALYs) have fallen substantially, the decline masks troubling trends among adolescents and in low-income regions. The study, published in Pediatric Discovery, examined hemorrhagic stroke (HS) and ischemic stroke (IS) among children and adolescents aged 0–19 years across 204 countries and territories using Global Burden of Disease 2021 modeled estimates. The findings carry significant implications for health systems, funders, and clinicians, showing that progress in neonatal and pediatric care has not reached all children equally.
In 2021, an estimated 2.7 million children and adolescents were living with pediatric stroke, with HS accounting for 41.4% of cases and IS for 58.6%. Stroke-related DALYs fell from about 5.9 million in 1990 to 2.4 million in 2021, and deaths numbered about 24,700. However, incident cases among adolescents aged 10–19 years rose from approximately 144,300 to 152,500, with incidence peaking at ages 15–19. The authors caution that falling DALYs and deaths should not be read as a simple success story; rather, they signal that better care works but is unevenly distributed.
Hemorrhagic stroke remained disproportionately severe, contributing 78.3% of DALYs and 85.9% of deaths. Low-SDI regions carried the highest age-standardized burdens: HS prevalence rose from about 146,600 cases in 1990 to 267,200 in 2021, and the HS-related age-standardized DALY rate reached 4,157.3 per 100,000. Western Sub-Saharan Africa recorded the steepest prevalence increase (estimated annual percentage change 2.60), while East Asia achieved the largest decline (−1.28). China had the most prevalent cases (about 350,200), whereas India had the most DALYs (about 227,300) and incident cases in 2021. Sex differences emerged as well: males had more HS, while females had more IS.
The authors emphasize that early recognition, timely access to imaging and neurosurgical care, and rehabilitation must reach the children at highest risk, especially in resource-limited settings. They outline three priorities: improving acute stroke care, particularly for HS in low-resource settings; strengthening prevention by addressing infections, malnutrition, congenital heart disease, trauma, and lifestyle-related risks with age- and sex-specific strategies; and expanding physical, occupational, and speech rehabilitation. Better referral pathways, telemedicine, thrombectomy where feasible, and routine surveillance could improve outcomes.
Because the burden is increasingly concentrated in low-SDI regions and among adolescents, funders and health systems should pair neonatal-care gains with adolescent-focused prevention and rehabilitation. The authors also call for research on economic costs and intervention effectiveness in low- and middle-income countries (LMICs), where families often bear catastrophic expenses. Such investments could reduce long-term disability and inequity. The study’s findings make clear that targeted action is now essential to close widening gaps in pediatric stroke care.
