Burden of Stroke in China From 1990 to 2023: Analysis From the Global Burden of Disease Study 2023

Background: China has initiated a national stroke program since 2011. Understanding the magnitude of stroke burden in China is crucial for modulating related policies. Objective: This study aimed to analyze stroke status in China from the 2023 Global Burden of Disease study. Methods: The 2023 Global Burden of Disease study was the source of the estimation of stroke burden. The data of deaths, incidence, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost attributable to stroke and its subtypes from 1990 to 2023 were analyzed. The mortality-to-incidence ratio was calculated to quantify the proportion of incident stroke cases that result in deaths. DALY decomposition analysis was applied to quantify how stroke burden has shifted between mortality and long-term disability over time. Sex-specific characteristics were also compared. Results: From 1990 to 2023, absolute stroke incidence (1.87-4.23 million) and prevalence (11.56-26.68 million) increased substantially, with ischemic stroke as the primary driver. Age-standardized incidence declined from 246.15 to 192.19 per 100,000 populations, while mortality significantly reduced from 302.72 to 92.83 per 100,000 populations. DALYs and years of life lost decreased 9.3% and 11%, respectively, while YLDs increased more than double. Mortality-to-incidence ratio fell for all subtypes except subarachnoid hemorrhage, indicating improved survival. Male individuals bore a heavier burden in total stroke and ischemic stroke, while subarachnoid hemorrhage showed female predominance in prevalence and YLDs. DALY decomposition revealed that YLDs contribution rose from 5.8% to 14.5%. Conclusions: From 1990 to 2023, despite declining age-standardized rates, stroke burden in China grew due to ischemic stroke and population changes. The shifting burden toward disability and persistent sex disparities highlights the need for tailored prevention, rehabilitation, and gender-specific interventions.