National and subnational burden of ischaemic stroke in Kenya from centralisation to devolution, 1990–2023, with forecasts to 2033: an analysis for Global Burden of Disease Study 2023

Background Ischaemic stroke burden in sub-Saharan Africa is rising, yet county-level evidence for Kenya's devolved health system remains scarce. We extracted and analysed county-level estimates of Ischaemic stroke burden across Kenya's 47 counties (1990–2023) and forecasted trends to 2033 to inform decentralised policy interventions. Methods Using GBD 2023 data, we extracted and analysed ischaemic stroke incidence, prevalence, mortality, and DALYs by age, sex, and county. Joinpoint regression analysed 1990–2023 trends (EAPC, 95% CI); ARIMA projected 2024–2033 burden. Comparative risk assessment quantified attributable factors. Findings In 2023, Ischaemic stroke caused 11,328 deaths and 317,719 DALYs nationally. Age-standardised incidence rose slightly (EAPC 0.22%), while mortality and DALY rates declined significantly (EAPCs −0.69% and −0.45%). County-level disparities were pronounced: Kwale had the highest incidence (108.97 per 100,000), Garissa the highest mortality (46.49), and Siaya the lowest incidence (57.77). High systolic blood pressure contributed to 35% of the burden. Mortality declines accelerated after Kenya's 2013 devolution. Projections indicate mortality falling to approximately 24.5 per 100,000 by 2033, yet incidence rising at 85–86 per 100,000 signalling treatment gains but stalled prevention. Working-age men (40–65) experienced the highest mortality burden, though women exceeded men at ages 85+. Interpretation Ischaemic stroke remains a major cause of death and disability. Rising incidence alongside declining mortality signals treatment success but persistent prevention gaps. Evidence confirms devolved governance improves healthcare access and outcomes. African nations should adopt decentralised models, strengthen primary prevention, and advance universal health coverage to manage the growing disability burden. Funding No funding was received.