Using GBD 2021 data from 1990 to 2021, the study found that absolute cases of COPD, ischemic stroke, and intracerebral hemorrhage increased while age-standardized incidence rates declined, with air pollution and tobacco as the main shared attributable risks, and that prevention priorities should reflect disease burden and local resources, with sustained attention to tobacco exposure and air pollution.
Absolute incident cases of COPD, ischemic stroke (IS), and intracerebral hemorrhage (ICH) increased globally from 1990 to 2021, while age-standardized incidence rates declined.
In 2021, COPD had the highest global age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALY rate (ASDR) of the three diseases.
The disease with the highest burden at country level differed by metric.
Air pollution accounted for the largest global attributable DALY burden among the shared Level 2 risk categories, whereas tobacco predominated in high-SDI settings.
Exploratory BAPC projections suggest continued ASDR declines through 2050, with IS potentially having the highest projected ASDR.
Age-specific burden is increasingly shifting toward older populations.
The study examined temporal, geographical, age-, sex-, and SDI-specific patterns, and the geographical overlap of the diseases does not establish comorbidity, causality, or clinical predictive value.
This study used Global Burden of Disease data from 1990 to 2021 to compare three conditions: COPD (a chronic lung disease), ischemic stroke (caused by blocked blood flow to the brain), and intracerebral hemorrhage (bleeding in the brain). The total number of new cases of each rose over the three decades, probably reflecting growing and aging populations, while rates adjusted for age declined. In 2021, COPD had the highest age-standardized incidence, death, and disability-adjusted life-year rates of the three globally. The leading disease varied by country and by measure: COPD had the highest incidence rate in 187 countries and territories, ischemic stroke the highest death rate in 110, and intracerebral hemorrhage the highest DALY rate in 95. Air pollution was the largest shared contributor to the burden overall, while tobacco was most important in high-income (high-SDI) settings. Exploratory projections to 2050 suggest rates will keep falling, with the burden shifting toward older people. This research suggests that prevention planning could be tailored to local disease burden and resources, with continued attention to tobacco and air pollution. The authors caution that the geographic overlap among these diseases does not show that they occur together in the same individuals, that one causes another, or that one predicts the other, and the projections are exploratory.
Chen B, Liao Z, Lv C, Yang L, Sun F, Mei Z. (2026). Divergent epidemiologic, shared risks: a comparative global analysis of COPD, ischemic stroke, and intracerebral hemorrhage.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2750579