ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
This article is part of the Research TopicSex and Gender Differences in Cerebrovascular Diseases and StrokeView all articles
Subtype and Gender-Differentiated Burden of Stroke in China (1990-2021): Attributable Risk Factors and Future Projections Based on the Global Burden of Disease Study 2021
Provisionally accepted
- 1North China University of Science and Technology, Tangshan, China
- 2Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- 3Hua Ren Orthopedic Hospital, Tangshan, China
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Introduction Using data from the Global Burden of Disease Study 2021 (GBD 2021), this study analyzed the 32-year trends (1990-2021) of stroke burden in China, quantified the attributable risk factors, and projected the future trajectories (2022-2035) of stroke and its subtypes. It also emphasized subtype-and gender-specific disparities to provide evidence for precision prevention. Methods Age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years rate (ASDR) of stroke were analyzed using estimated annual percentage change (EAPC) and Joinpoint regression. The population attributable fraction (PAF) was used to quantify the burden of stroke-related disability-adjusted life years(DALYs) attributed to risk factors, and Bayesian age-period-cohort (BAPC) modeling was applied to project future burden. Results In 2021, the ASIR, ASPR, ASMR, and ASDR of stroke in China were 204.75, 1301.42, 138.03, and 2648.02 per 100,000 populations, respectively. From 1990 to 2021, ASMR (EAPC=-1.92; 95% CI: - 2.17 to -1.67) and ASDR (EAPC=-2.05; 95% CI: -2.25 to -1.86) of stroke decreased, while ASPR increased (EAPC=0.34; 95% CI: 0.31 to 0.38). Subtype analysis showed opposing trends: IS ASIR (EAPC=0.94; 95% CI: 0.88 to 1.00) and ASPR (EAPC=1.02; 95% CI: 0.96 to 1.08) increased, whereas ICH and SAH burdens decreased (ICH ASIR EAPC=-2.24; SAH ASIR EAPC=-3.70). Males had higher ASRs than females in 2021, except for ICH ASPR. High systolic blood pressure (PAF=56.04%), ambient particulate matter pollution (PAF=24.37%), and smoking (PAF=17.91%) were the top three risk factors for stroke-related DALYs; high LDL cholesterol (PAF=28.42%) ranked second for IS. Projections indicated that by 2035, overall stroke ASIR (from 208.27 to 194.07 per 100,000) and ASMR (from 139.94 to 100.34 per 100,000) would decrease, but IS ASIR would rise to 156.44 per 100,000 (from 139.98 per 100,000 in 2022). Conclusions The stroke burden in China shows a downward trend, with a subtype-specific feature of increasing IS and decreasing ICH/SAH. High systolic blood pressure is the corepotential risk factor for stroke, with variations across subtypes and genders. Targeted interventions such as smoking control for males, sodium intake reduction for females, and LDL cholesterol management for IS, are urgently needed to mitigate the future IS burden.
Keywords: Stroke, China, Global Burden of Disease study 2021, Subtype-specific, Gender difference
Received: 17 Aug 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Wang, Xu, Zhang, Tan, Wang, Wang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiachun Xu, xujiachunzhu@163.com
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