Temporal Trend and Attributable Risk Factors of Stroke Burden in China, 1990-2019: Findings From the Global Burden of Disease Study 2019

Background: Limited information exists on the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels. The aim of this analysis from the Global Burden of Disease Study (GBD) 2019 is to investigate the disease burden of stroke and its risk factors at national and provincial levels of China from 1990 to 2019. Methods: Following the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, three subcategories of stroke and across 33 province-level administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. Findings: The annual stroke incidence increased from 1.76 million in 1990 to 3.94 million in 2019; the age-standardised incidence rate declined from 221.5 per 100,000 population in 1990 to 200.8 per 100,000 population in 2019. Deaths due to stroke increased by 59.0%, reaching 2.19 million in 2019. The age-standardised mortality rate decreased by 39.8%, reaching 127.2 per 100,000 population in 2019. The number of stroke prevalence overall increased by 147.5% (from 11.62 million in 1990 to 28.76 million in 2019). From 1990 to 2019, the age-standardised prevalence rate increased by 13.2% for overall stroke and 33.5% for ischemic stroke, and decreased by 31.9% for intracerebral hemorrhage and 21.9% for subarachnoid hemorrhage. A substantial reduction was observed in the age-standardised DALYs rate (41.6%) of stroke from 1990 to 2019. Moreover, there were marked differences of these estimates stratified by sex, age, stroke subtype, and across province. High systolic blood pressure , high fasting blood glucose , p articulate matter pollution exposure , and smoking were four major risk factors for stroke burden in 2019. Interpretation: This study demonstrates that the disease burden of stroke is still severe for the Chinese population, although the age-standardised incidence and mortality rate have decreased since 1990. There was substantial variation of these estimates among different provinces which suggested the necessary of targeted stroke intervention. Blood pressure and blood glucose management through regular health care and air pollution control measures might help reduce the stroke burden in China. Funding Information: This work was supported by the National Key R&D Program of China (2018YFA0606200). The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. Declaration of Interests: The authors declare they have no actual or potential competing financial interests. Ethics Approval Statement: This study was approved by the Ethical Review Committee of the National Center for Chronic and Non-communicable Disease Control and Prevention of the Chinese Center for Disease Control and Prevention. No individual identifiable information was used in this study.