Global Trends in Stroke Burden Attributable to Secondhand Smoke, 1990-2024: A Meta-regression Analysis Using GBD Data
Thanuja Mora1, Surbhi Dumra2, Laxmi Mahita Reddy Paripati3, Anwar Syed4, Sushma Kalva5, Rushda Mundampra6, Periyaiyadever Samuganathan7, Harshavardhan Parvathi8
1Gandhi Medical College, Hyderabad, 2ESIC Medical College and Hospital, Faridabad, 3Malla Reddy Institute of Medical Sciences, Suraram, 4Bhaskar Medical College, Moinabad, 5Osmania Medical College, Hyderabad, 6Petre Shotadze Tbilisi Medical Academy, Georgia, 7Melaka Manipal Medical College, Malaysia, 8Sierra view Medical Center, Porterville
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.
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