Pediatric stroke has been less recognized than adult stroke, and its risk factors, epidemiology and outcomes remain insufficiently understood. Over three decades, neonatal and pediatric care advances in high-income settings have reduced mortality and disability, but absolute burdens remain high in low- and middle-income countries (LMICs), driven by population growth, limited diagnostic access and persistent healthcare disparities. Hemorrhagic stroke (HS), including intracerebral and subarachnoid hemorrhage, causes most pediatric stroke disability-adjusted life years (DALYs), especially where timely neurosurgical care is unavailable, while ischemic stroke (IS) incidence has risen among older children and adolescents. Infections, congenital heart disease, trauma and sickle cell disease further shape risk. Given these challenges, in-depth research is needed on age-, sex- and sex and sociodemographic index (SDI)-stratified pediatric stroke trends to guide targeted prevention and resource allocation.
The study, from researchers at 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), was published (DOI: 10.1002/pdi3.70031) in Pediatric Discovery on 31 December 2025. Using Global Burden of Disease (GBD) 2021 modeled estimates for 204 countries and territories, the team analyzed pediatric HS and IS prevalence, incidence, deaths and DALYs from 1990 to 2021, stratified by age, sex and SDI, and calculated EAPCs to quantify long-term trends and inequalities. The analysis focused specifically on children rather than all-age stroke.
In 2021, an estimated 2.7 million children and adolescents were living with pediatric stroke worldwide; HS accounted 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 about 24,700, but incident cases among adolescents aged 10–19 years rose from approximately 144,300 to 152,500. Incidence increased with age, peaking at 15–19 years. HS remained disproportionately severe, contributing 78.3% of DALYs and 85.9% of deaths. Low-SDI regions carried the highest age-standardized burdens, with HS prevalence rising from about 146,600 cases in 1990 to 267,200 in 2021; their 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, whereas females had more IS. The highest HS age-standardized prevalence rate occurred in low-SDI settings (222.0 per 100,000), whereas the highest IS rate occurred in high-SDI settings (316.3 per 100,000). Adolescent DALYs in low-SDI regions rose for both subtypes. The authors also reported a modest post-2015 rebound in age-standardized prevalence.
The authors said the findings should not be read as a simple success story. They said falling DALYs and deaths show that better neonatal and pediatric care can work, but rising adolescent incidence and persistently high HS mortality in low-SDI regions signal that progress is uneven. 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. They said health systems must close these gaps. They said targeted action is now essential.
The findings support 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 LMICs, where families often bear catastrophic expenses. Such investments could reduce long-term disability and inequity.
###
References
DOI
10.1002/pdi3.70031
Original Source URL
https://doi.org/10.1002/pdi3.70031
Funding information
General Project of the Chongqing Natural Science Foundation (Grant cstc2021jcyj msxmX0606) and Key Project of Chongqing Municipal Education Commission (Grant KJ2024004109887015).
About Pediatric Discovery
Pediatric Discovery is a Gold Open Access publication and peer-reviewed international journal. The journal aims to advance the health and well-being of infants, children, and adolescents by disseminating cutting-edge discovery and knowledge in the field. It provides a platform for publishing and discussing the most important and state-of-the-art basic, translational and clinical discoveries affecting child and adolescent health and disorders in all aspects of pediatric medicine. The journal has been indexed by DOAJ and PMC. Currently, it does not charge any submission fees. The Article Publication Charge (APC) is currently waived for accepted manuscripts.