National and provincial trends of mortality and years of life lost due to stroke in children and adolescents in China, 2005–2020: An analysis of national mortality surveillance data

Background: Stroke is associated with substantial mortality among children and adolescents, yet evidence on the death burden of stroke in this group in China is scarce. Aims: To assess the trends of mortality and years of life lost (YLL) due to stroke in children and adolescents in China. Methods: We estimated the number and age-standardized rate of death and YLL caused by stroke and its subtypes among children and adolescents aged 0–19 years in China and its provinces from 2005 to 2020, utilizing data from National Mortality Surveillance System. Results: In China, the age-standardized mortality rate due to stroke among children and adolescents aged 0–19 years decreased from 1.40/100,000 to 0.51/100,000 during 2005–2020, and the YLL rate decreased from 116.28/100,000 to 38.79/100,000. During 2005–2020, intracerebral hemorrhage (ICH) consistently showed significantly higher age-standardized mortality rate than ischemic stroke (IS) and subarachnoid hemorrhage (SAH). In 2020, the mortality rate of ICH was 11.35-fold and 4.96-fold greater than that of IS and SAH, respectively (ICH 0.40/100,000, IS 0.04/100,000, SAH 0.08/100,000). Overall, males among children and adolescents exhibited higher age-standardized mortality and YLL rate due to stroke compared to females. Notably, the stroke mortality rate in 15–19 years age group increased by 16.10% during 2005–2020, primarily attributed to the significant increases in mortality rate of ICH and SAH among males in this age group (ICH males 25.51%, SAH males 107.83%). In 2020, Yunnan (1.56/100,000), Tibet (1.54/100,000), and Henan (1.47/100,000) had the highest age-standardized mortality rate of stroke among children and adolescents, while Shanghai, Fujian and Jiangsu had the lowest rates. In addition, a negative association was observed between the age-standardized YLL rates of stroke among individuals aged 0–19 years and the socio-demographic index across 31 provinces in China from 2005 to 2020. Conclusion: In China, the death burden of ICH among children and adolescents was considerably heavier than that of SAH and IS. The rising mortality rate of ICH and SAH among males aged 15–19 years requires greater emphasis. Targeted interventions for stroke in children and adolescents should be expedited to reduce the disease burden in this particular population.