The Stroke Burden in China and Its Long-Term Trends: Insights from the Global Burden of Disease (GBD) Study 1990-2021

Abstract

Background and aim: To explore effective preventive strategies for stroke, it is of paramount importance to systematically assess its risk factors. Leveraging the Global Burden of Disease (GBD) data, this study aims to retrospectively analyze the long-term trends and epidemiological characteristics of stroke in China.

Methods and results: Drawing on the GBD 2021 data, this study conducted a comprehensive analysis of the burden of stroke in the Chinese population, encompassing prevalence, incidence, mortality, years of life lost (YLL), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Subsequently, we examined the temporal trends of these indicators and employed a Joinpoint regression analysis coupled with an age-period-cohort (APC) model to precisely dissect mortality and incidence patterns. Furthermore, we delved into the attributable burden of stroke. The results indicated that the prevalence of stroke in China reached 26 million in 2021, representing a 104.26 % increase since 1990. Compared to 1990, the number of DALYs attributable to stroke increased by 45.25 %. Joinpoint analysis revealed a declining trend in incidence rates, while mortality rates showed a significant reduction. The APC model fitting outcomes suggested that prevalence rates were higher in recent generations than in the past, with an increase observed within the same age cohort. Notably, in 2019, the primary burden of cardiovascular diseases (CVDs) stemmed from metabolic risks, particularly hypertension, followed by air pollution particulate matter as an environmental risk factor.

Conclusions: Given China's vast population base and rapid aging process, the burden of stroke has emerged as a significant public health concern.

Keywords: Age-period-cohort model; China; Global Burden of Disease; Joinpoint regression; Public health; Risk factors; Stroke.