Eur Stroke J. 2026 Jul 6;11(7):aakag082. doi: 10.1093/esj/aakag082.
ABSTRACT
INTRODUCTION: The burden of ischaemic stroke in Europe has evolved over recent decades, shaped by changes in prevention, acute care and population ageing. Understanding long-term trends in mortality and disability is essential for guiding policy and service planning.
PATIENTS AND METHODS: Using Global Burden of Disease (GBD) 2023 estimates, we analysed age-standardised disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) for ischaemic stroke across all European countries from 1990 to 2023. We estimated country-specific annual percentage changes (EAPCs), assessed non-linear trajectories, examined shifts in the fatal vs non-fatal composition of DALYs and synthesised trends using mixed-effects models and descriptive meta-analytic pooling.
RESULTS: Disability-adjusted life year rates declined in every European country, with the steepest reductions in Central and Western Europe and more modest improvements in parts of Eastern and Southeastern Europe. Years of life lost declines closely paralleled DALY trends, indicating that falling premature mortality was the main driver of the overall reduction. Years lived with disability trends were smaller and more heterogeneous across countries. Mixed-effects modelling indicated average European EAPCs of -3.40% (95% CI, -3.74 to -3.05) for DALYs, -1.26% (-1.43 to -1.09) for YLLs and -3.86% (-4.26 to -3.46) for YLDs. Meta-analytic pooling of national patterns showed large declines in YLLs (random-effects EAPC -3.81%) relative to YLDs (-0.86%).
DISCUSSION AND CONCLUSION: Ischaemic stroke burden has fallen substantially across Europe, driven primarily by reductions in premature mortality. Slower progress in disability outcomes and persistent regional disparities highlight the need to strengthen long-term rehabilitation and address uneven improvements across the continent.
PMID:42479895 | DOI:10.1093/esj/aakag082