A global analysis of pediatric stroke burden from 1990 to 2021 reveals that while overall deaths and disability-adjusted life years (DALYs) have declined, incidence among adolescents and hemorrhagic stroke mortality in low-sociodemographic-index (SDI) regions have increased, according to a study published in Pediatric Discovery on December 31, 2025.
Researchers from Children's Hospital of Chongqing Medical University, the National Clinical Research Center for Child Health and Disorders, and collaborators at Army Medical University (Third Military Medical University) used Global Burden of Disease 2021 modeled estimates for 204 countries and territories to assess prevalence, incidence, deaths, and DALYs for hemorrhagic stroke (HS) and ischemic stroke (IS) among children and adolescents aged 0–19 years. The team calculated estimated annual percentage changes (EAPCs) by age, sex, and SDI to quantify long-term trends and inequalities.
In 2021, an estimated 2.7 million children and adolescents were living with pediatric stroke worldwide, with HS accounting for 41.4% 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 approximately 24,700. However, incident cases among adolescents aged 10–19 years rose from roughly 144,300 to 152,500, with incidence peaking at ages 15–19. HS remained disproportionately severe, contributing 78.3% of DALYs and 85.9% of deaths.
Low-SDI regions carried the highest age-standardized burdens. HS prevalence in these settings 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 (EAPC 2.60), while East Asia achieved the largest decline (EAPC −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 also emerged: males had more HS, while females had more IS. The highest HS age-standardized prevalence rate occurred in low-SDI settings (222.0 per 100,000), while the highest IS rate occurred in high-SDI settings (316.3 per 100,000). Adolescent DALYs in low-SDI regions rose for both subtypes, and the authors reported a modest post-2015 rebound in age-standardized prevalence.
The authors cautioned that the findings should not be read as a simple success story. Falling DALYs and deaths demonstrate that better neonatal and pediatric care can work, but rising adolescent incidence and persistently high HS mortality in low-SDI regions signal uneven progress. They emphasized that early recognition, timely access to imaging and neurosurgical care, and rehabilitation must reach the children at highest risk, especially in resource-limited settings, rather than remaining concentrated in high-income health systems.
The study supports three priorities: improving acute stroke care, especially 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 early recognition and 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, where families often bear catastrophic expenses. Such investments could reduce long-term disability and inequity. The research was supported by the General Project of the Chongqing Natural Science Foundation (Grant cstc2021jcyj msxmX0606) and the Key Project of Chongqing Municipal Education Commission (Grant KJ2024004109887015).
