Abstract Body: Introduction: Ischemic stroke is among the leading global health burdens due to the significant resultant morbidity and mortality. Therefore, the assessment of the temporal trends in the burden of ischemic stroke is of substantial importance in risk stratification and public health policy formation, particularly in regions with limited resources such as the Middle East.
Methods: Data, including age-standardized rates per 100,000 persons, regarding the incidence, mortality, and disability-adjusted life years (DALYs) of ischemic stroke in the Middle East for the period 1990-2019 was retrieved from the Global Burden of Disease database to evaluate the burden of ischemic stroke in the region. Joinpoint Analysis software was utilized to calculate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) to determine the temporal trends in the incidence, mortality, and DALYs.

Results: Over the span of 3 decades, an estimated total of 2,776,802 ischemic stroke-related mortalities with an approximately 1:1 male to female ratio were reported in the Middle East. Overall, there was a statistically significant decline in age-standardized mortality rate for all the Middle Eastern nations except for the United Arab Emirates where a statistically insignificant increase in ischemic stroke-related mortality was noted with an AAPC of 0.29 (95%CI -0.48 to 1.01; p=0.47). Qatar witnessed the most significant decrement in age-standardized mortality rate with an AAPC of -3.60 (95CI% -3.91 to 3.28; p<0.0001), followed by Lebanon with an AAPC of -3.34 (95CI% -3.43 to -3.26; p<0.0001). In terms of age-standardized incidence rate, a general decline was noted in the majority of the nations, with the most prominent decline identified in Qatar with AAPC of -1.34 (95%CI -1.38 to -1.30; p<0.0001). However, Yemen has witnessed a statistically significant incline in age-standardized incidence rate with an AAPC of 0.041 (95CI% 0.036 to 0.047; p<0.0001). A total of 61,391,636 DALYs were attributed to ischemic stroke in the Middle East over 30 years. Analysis of the age-standardized DALY rate revealed a statistically significant decline in all reported nations, with the most significant decline reported in Qatar with an AAPC of -3.28 (95%CI -3.55 to -3.00; p<0.0001).

Conclusion: In conclusion, the Middle East witnessed a significant decline in the age-standardized incidence, mortality and DALYs rate across the vast majority of the countries over a span of 30 years.