A new global analysis of pediatric stroke finds that while deaths and disability from the condition have fallen substantially over three decades, the burden is shifting toward adolescents and low-income regions, where severe hemorrhagic strokes continue to cause most disability and death. The study, published in Pediatric Discovery on 31 December 2025, examined hemorrhagic and ischemic stroke among children and adolescents aged 0–19 across 204 countries and territories from 1990 to 2021.
In 2021, an estimated 2.7 million children and adolescents were living with pediatric stroke worldwide. Hemorrhagic stroke accounted for 41.4% of prevalent cases and ischemic stroke for 58.6%. Stroke-related disability-adjusted life years, or DALYs, fell from about 5.9 million in 1990 to 2.4 million in 2021, and deaths numbered about 24,700. However, incident cases among adolescents aged 10–19 rose from approximately 144,300 to 152,500, with incidence increasing with age and peaking at 15–19 years.
Hemorrhagic stroke remained disproportionately severe, contributing 78.3% of DALYs and 85.9% of deaths. Low-sociodemographic-index regions carried the highest age-standardized burdens, with hemorrhagic stroke prevalence rising from about 146,600 cases in 1990 to 267,200 in 2021. Their hemorrhagic stroke-related age-standardized DALY rate reached 4,157.3 per 100,000. Western Sub-Saharan Africa recorded the steepest prevalence increase, with an estimated annual percentage change of 2.60, while East Asia achieved the largest decline at −1.28. China had the most prevalent cases at about 350,200, whereas India had the most DALYs at about 227,300 and the most incident cases in 2021.
Sex differences also emerged: males had more hemorrhagic stroke, while females had more ischemic stroke. The highest age-standardized prevalence rate for hemorrhagic stroke occurred in low-SDI settings at 222.0 per 100,000, whereas the highest rate for ischemic stroke occurred in high-SDI settings at 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 researchers, from Children's Hospital of Chongqing Medical University, the National Clinical Research Center for Child Health and Disorders, and Army Medical University, cautioned that the findings should not be read as a simple success story. Falling DALYs and deaths show that better neonatal and pediatric care can work, they said, but rising adolescent incidence and persistently high hemorrhagic stroke 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.
The study supports three priorities: improving acute stroke care, especially for hemorrhagic stroke 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 low- and middle-income countries, where families often bear catastrophic expenses. Such investments could reduce long-term disability and inequity.
