Abstract Details

Title Global Trends in Stroke Burden Attributable to Secondhand Smoke, 1990-2024: A Meta-regression Analysis Using GBD Data

Topic Global Health and Neuroepidemiology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 20-005

Objective To quantify temporal, subtype-specific, and sex-specific trends in global stroke burden attributable to secondhand smoke (SHS) from 1990-2024 and to identify policy-linked inflection points.

Background Secondhand smoke (SHS) remains a major modifiable risk factor associated with cerebrovascular and cardiovascular diseases, yet its evolving global impact is not fully characterized. Previous analyses, limited to data through 2019, were primarily descriptive and did not quantify inflection points or subtype-specific disparities.

Design/Methods Data on SHS-attributable stroke burden were extracted from the Global Burden of Disease (GBD) 2024 study. Outcomes included the age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and population-attributable fraction (PAF), stratified by stroke subtype and sex. Meta-regression models assessed the independent effects of year and subtype, while joinpoint regression estimated annual percentage change (APC) and average annual percentage change (AAPC) to identify inflection points, with model selection based on the Bayesian Information Criterion.

Results Globally, from 1990-2024, SHS-attributable ischemic stroke ASMR declined from 2.67 to 1.28, and hemorrhagic stroke ASMR declined from 3.59 to 1.75 per 100,000 population. DALY rates decreased in parallel, while PAFs declined modestly (ischemic: 3.6% to 2.9%; hemorrhagic: 5.0% to 4.2%). Males exhibited consistently higher ASMR values. Meta-regression confirmed year as a highly significant predictor of decline (p < 0.001; R² = 0.979). Joinpoint analysis identified an accelerated ischemic stroke burden decline after 2005 (APC = −3.5%), coinciding with global smoke-free policy expansion, and a later inflection for hemorrhagic stroke around 2010 (APC = −2.7%).

Conclusions Global SHS-attributable stroke burden has declined substantially, coinciding with major tobacco control milestones. Persistent PAFs, particularly for hemorrhagic stroke and among males, highlight ongoing exposure inequities. These findings extend prior descriptive analyses by linking trend inflections to global policy adoption and underscore the need to sustain and strengthen SHS prevention within noncommunicable disease strategies.

Authors/Disclosures
Syeda Safiya Hussaini, MD PRESENTER	An immediate family member of Syeda Safiya Hussaini, MD has received personal compensation for serving as an employee of HelloFresh. Syeda Safiya Hussaini, MD has stock in Eli Lilli. Syeda Safiya Hussaini, MD has stock in Abbvie. Syeda Safiya Hussaini, MD has stock in Apple. Syeda Safiya Hussaini, MD has stock in Nvidia. Syeda Safiya Hussaini, MD has stock in Amazon.
Thanuja Mora, MBBS (Krishna Institute of Medical Sciences)	Dr. Mora has nothing to disclose.
Surbhi Dumra, MBBS	Dr. Dumra has nothing to disclose.
Laxmi Mahita Reddy Paripati, MBBS	Dr. Paripati has nothing to disclose.
Anwar Syed	Dr. Syed has nothing to disclose.
Sushma Kalva, MBBS	Dr. Kalva has nothing to disclose.
Rushda Mundampra, MBBS	Dr. Mundampra has nothing to disclose.
Dever Samuganathan, MD	Dr. Samuganathan has nothing to disclose.
Harshavardhan Parvathi, MD	Mr. Parvathi has nothing to disclose.