To analyze the long-term trends and burden of ischemic stroke in South Asian countries from 1990 to 2023 using data from the Global Burden of Disease (GBD) Study 2023.

Ischemic stroke is a leading cause of death and disability worldwide. South Asia has an enormous burden as a result of increased vascular risk factors and limited access to preventative and rehabilitative therapy. Understanding the temporal patterns in incidence, mortality, and disability is critical for driving regional health policy.

Data on ischemic stroke incidence, prevalence, deaths, and disability-adjusted life years (DALYs) were obtained from the GBD 2023 database for six South Asian countries: Pakistan, India, Bangladesh, Nepal, Bhutan, and Sri Lanka. Age-standardized rates per 100,000 population were analyzed for both sexes from 1990 to 2023. Temporal trends were assessed using Joinpoint regression to calculate the annual percent change (APC) and the average annual percent change (AAPC), along with 95% confidence intervals (CIs).

Between 1990 and 2023, the age-standardized incidence rate of ischemic stroke in South Asia increased from 79.4 to 101.7 per 100,000, while the prevalence rose from 680.5 to 905.3 per 100,000. Despite this rise, the age-standardized mortality rate declined from 94.6 to 72.1 per 100,000 (AAPC: –1.3%; 95% CI: –1.6 to –0.9), and DALY rates fell from 2,180.4 to 1,520.7 per 100,000 (AAPC: –1.5%; 95% CI: –1.9 to –1.0). Pakistan and Bangladesh had the highest mortality and DALY rates, whereas Sri Lanka consistently showed the lowest. Males experienced slightly higher mortality trends than females across all years.

Although mortality and DALY rates from ischemic stroke have declined, the increasing incidence and prevalence indicate that the overall burden remains high in South Asia. Strengthening preventive measures, early diagnosis, and long-term stroke care programs is essential to reduce this growing public health challenge.