Cardiovascular

Epidemiological trends and sex disparities in stroke disability-adjusted life years and mortality in Middle East and North Africa (MENA): An analysis of the Global Burden of Disease Data (1990-2023) with machine learning forecasting to 2050.

TL;DR

Stroke-related DALYs and mortality declined significantly across MENA from 1990 to 2023, with females showing steeper gains than males, and SARIMA forecasts project a 78.8% reduction in DALYs and 83.6% reduction in mortality by 2050, though persistent sex and country disparities underscore the need for equitable, sustained interventions.

Key Findings

Regional stroke DALYs declined over the 1990–2023 period, with a steeper decline in females than males.

  • Overall estimated annual percentage change (EAPC) for stroke DALYs was -2.595 (95% CI: -2.641 to -2.549).
  • Female EAPC was -2.697 (95% CI: -2.758 to -2.636), steeper than male EAPC of -2.487 (95% CI: -2.537 to -2.438).
  • Trends were assessed via estimated annual percentage changes using linear regression on log-transformed age-standardized rates.
  • Data were drawn from the Global Burden of Disease 2023 dataset for 21 MENA countries stratified by sex (ICD-10: I60-I69).

Stroke mortality (age-standardized death rates) also declined significantly across the MENA region over the study period.

  • Overall EAPC for stroke deaths was -2.51 (95% CI: -2.556 to -2.464).
  • The analysis covered 1990 to 2023 using GBD 2023 data.
  • Age-standardized rates were extracted for both the overall MENA region and 21 constituent countries.

There was substantial country-level variation in the rate of stroke DALY decline across MENA.

  • Qatar showed the fastest DALY decline with an EAPC of -4.437 (95% CI: -4.859 to -4.014).
  • Libya showed the slowest DALY decline with an EAPC of -1.087 (95% CI: -1.205 to -0.970).
  • This variation likely reflects differences in risk factor control, healthcare access, conflict exposure, and demographic shifts across 21 MENA countries.

SARIMA forecasting models project a 78.8% reduction in stroke DALYs by 2050 for the MENA region.

  • Projected decline is from 1895 to 401 per 100,000 age-standardized DALY rate.
  • SARIMA (Seasonal Autoregressive Integrated Moving Average) models were fitted to regional time-series data for both sexes combined.
  • 95% prediction intervals were constrained to nonnegative values.
  • The lower 95% confidence intervals reach zero by 2043, reflecting long-term uncertainty in the forecasts.

SARIMA forecasting models project an 83.6% reduction in stroke mortality by 2050 for the MENA region.

  • Projected decline is from 94 to 15 per 100,000 age-standardized mortality rate.
  • Forecasts extend from 2023 through 2050 with 95% prediction intervals.
  • The lower 95% CIs for mortality also reach zero by 2043.
  • These projections suggest near-elimination of stroke mortality by mid-century under current trend trajectories.

Females showed steeper stroke burden declines than males in most MENA countries, indicating sex-based disparities in epidemiological trends.

  • Female EAPC for DALYs (-2.697) exceeded male EAPC (-2.487) at the regional level.
  • Sex stratification was conducted across all 21 MENA constituent countries.
  • The authors note that despite female gains, persistent sex disparities remain and underscore the need for equitable interventions.
  • Disparities were noted in both prevention and acute management domains.

The study used GBD 2023 data covering 34 years (1990–2023) across 21 MENA countries to assess stroke burden using age-standardized rates.

  • Stroke was defined using ICD-10 codes I60–I69.
  • Age-standardized rates of stroke DALYs and deaths were extracted and stratified by sex.
  • Temporal trends were quantified using EAPCs derived from linear regression on log-transformed rates with 95% CIs.
  • SARIMA models were used for forecasting, with projections extending to 2050.

The authors attribute declining stroke burdens in MENA to progress in risk factor control and acute care.

  • Demographic shifts, conflict, and varying healthcare access were identified as contextual factors shaping regional stroke burden.
  • The authors note that forecasts indicate near-elimination of stroke mortality and substantial disability reduction by mid-century.
  • Persistent sex and country disparities were highlighted as requiring continued attention in prevention, acute management, and rehabilitation.

What This Means

This research suggests that the burden of stroke — measured by deaths and years of healthy life lost to disability — has been declining steadily across the Middle East and North Africa (MENA) region from 1990 to 2023. Using data from the Global Burden of Disease 2023 study covering 21 countries, the researchers found an average annual decline of about 2.6% in stroke-related disability and 2.5% in stroke deaths. Notably, women experienced faster improvements than men across most of the region, though disparities remain. Country-level differences were stark: Qatar saw the fastest improvements while Libya saw the slowest, highlighting how conflict, healthcare infrastructure, and risk factor management shape outcomes differently across the region. Using a statistical forecasting method called SARIMA, the researchers projected these trends forward to 2050. Their models suggest that if current trends continue, the MENA region could see stroke disability rates fall by nearly 79% (from about 1,895 to 401 per 100,000 people) and stroke death rates fall by about 84% (from 94 to 15 per 100,000 people) by mid-century. The lower bounds of their uncertainty estimates reach zero by around 2043, though the authors caution this reflects statistical uncertainty rather than a guaranteed outcome. This research suggests that substantial progress in stroke prevention and treatment has been made in MENA over recent decades, likely driven by better management of risk factors like high blood pressure and improved acute stroke care. However, the findings also highlight that progress is uneven across countries and between sexes, and that sustained, equitable investment in stroke prevention, emergency care, and rehabilitation will be needed — particularly in settings affected by conflict or with limited healthcare access — to maintain and accelerate these gains through mid-century.

Have a question about this study?

Citation

Khalil I, Wagdy M, Adnan Hashim G, Naeem Kareem H, Alshanqiti A, Hossain M, et al.. (2026). Epidemiological trends and sex disparities in stroke disability-adjusted life years and mortality in Middle East and North Africa (MENA): An analysis of the Global Burden of Disease Data (1990-2023) with machine learning forecasting to 2050.. Medicine. https://doi.org/10.1097/MD.0000000000050412