Hong He, Rong Cai
Despite declining global rates, the absolute burden of ischemic stroke in postmenopausal women continues to rise, particularly in low- and middle-income regions. Marked disparities exist across regions and risk factors, with Southern Sub-Saharan Africa facing a uniquely worsening epidemic. Urgent, context-specific interventions targeting metabolic risks, air pollution, and emerging climate-related threats are needed to mitigate this growing public health challenge.
PURPOSE: Ischemic stroke remains a leading cause of death and disability worldwide, with women aged ≥55 years, representing a presumed postmenopausal population, constituting a particularly vulnerable group due to physiological changes associated with menopause. However, comprehensive analyses specifically characterizing the global burden, temporal trends, and risk factor profiles in this group are lacking.
PATIENTS AND METHODS: Using data from the Global Burden of Disease Study 2021 (GBD 2021), we analyzed disability-adjusted life years (DALYs) and deaths. Temporal trends were assessed using estimated annual percentage changes (EAPCs) for rates and absolute numbers.
RESULTS: Globally, the 2021 DALY and death rates for ischemic stroke in postmenopausal women were 3358·13 (95% UI: 2924·14-3782·50) and 194·84 (95% UI: 164·39-220·57) per 100,000 population, respectively. While age-standardized rates declined modestly (DALY rate EAPC: -1·80; death rate EAPC: -1·78), absolute burden increased substantially (DALY number EAPC: 0·75; death number EAPC: 0·76), driven by population aging and growth. The high-middle SDI region exhibited the highest per capita burden, while low-middle SDI regions showed the steepest increases in absolute numbers (DALY number EAPC: 2·52). Southern Sub-Saharan Africa emerged as the most concerning region, with positive EAPCs for both DALY and death rates across all age groups (eg, DALY rate EAPC: 0·27 to 1·17). Metabolic risks-particularly high systolic blood pressure-were the leading contributors globally (2021 DALY rate: 3027·59). Notably, high temperature exposure was the only risk factor with consistently positive EAPCs (DALY rate EAPC: 1·07), indicating a growing burden attributable to climate-related factors.
CONCLUSION: Despite declining global rates, the absolute burden of ischemic stroke in postmenopausal women continues to rise, particularly in low- and middle-income regions. Marked disparities exist across regions and risk factors, with Southern Sub-Saharan Africa facing a uniquely worsening epidemic. Urgent, context-specific interventions targeting metabolic risks, air pollution, and emerging climate-related threats are needed to mitigate this growing public health challenge.