Pediatric Stroke Burden Shifts: 2.7 Million Children Affected Globally

A comprehensive new 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) has shed light on the long-term global burden of pediatric stroke. Published in Pediatric Discovery on 31 December 2025 (DOI: 10.1002/pdi3.70031), the analysis used Global Burden of Disease (GBD) 2021 modeled estimates to assess prevalence, incidence, deaths, and disability-adjusted life years (DALYs) for hemorrhagic stroke (HS) and ischemic stroke (IS) among children and adolescents aged 0–19 years across 204 countries and territories from 1990 to 2021. The study aimed to identify where progress has been made, where disparities are widening, and which age and stroke subtypes require targeted prevention and health-system strengthening.

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%. While stroke-related DALYs fell from about 5.9 million in 1990 to 2.4 million in 2021 and deaths numbered approximately 24,700, incident cases among adolescents aged 10–19 years rose from roughly 144,300 to 152,500. 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, and 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. Sex differences emerged: males had more HS, females more IS.

The authors caution that falling DALYs and deaths show better neonatal and pediatric care can work, but rising adolescent incidence and persistently high HS mortality in low-SDI regions signal uneven progress. They emphasize that early recognition, timely access to imaging and neurosurgical care, and rehabilitation must reach the highest-risk children, especially in resource-limited settings. The findings support three priorities: improving acute stroke care for HS in low-resource settings; strengthening prevention by addressing infections, malnutrition, congenital heart disease, trauma, and lifestyle 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 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.