Research on the trend of stroke burden in China from 1990 to 2021 and its age-period-cohort model_Chinese Journal of Evidence-Based Medicine

Authors：

GAO lingxiao , CAO Yuanyuan , TIAN Ruotong , DONG Xiaoyu , ZHANG Jiaqi , LYU Wenpei , CHENG Huaizhi ,  GUO Bin

DaQing Campus of Harbin Medical University, Daqing 163319, P. R. China;

Corresponding?author：

GUO Bin, Email: guobinlover@163.com

Keywords：

Stroke; Disease burden; Age-period-cohort model; Trend analysis; Risk factors

DOI：

10.7507/1672-2531.202411020

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the burden of stroke disease and age-period-cohort effects in China from 1990 to 2021, and to provide scientific basis for formulating relevant prevention and treatment strategies. Methods Based on GBD 2021 data, the Joinpoint regression model was used to analyze the trend of incidence rate, mortality and DALYs rate of stroke, and the APC model was used to analyze the impact of age, period and birth cohort on the incidence and mortality of stroke. Results From 1990 to 2021, the standardized incidence rate, standardized mortality rate and standardized DALYs rate of stroke in China showed an overall downward trend, with AAPC of ?0.37% (95%CI ?0.45% to ?0.29%), ?1.79% (95%CI ?1.99% to ?1.59%), and ?1.93% (95%CI ?2.07% to ?1.80%), respectively. The results of the age-period-cohort model showed that the incidence and mortality risks of stroke increased with age. The risk of female onset remained stable in the early stage but increased rapidly in the later stage, while the risk of male mortality showed a slight upward trend. The risk of onset and death generally decreased with the passage of the birth cohort. Hypertension had always been the primary risk factor for stroke, and metabolic factors such as high blood sugar had become the main factors affecting disease burden. Conclusion The burden of stroke disease in China is still relatively heavy, and differentiated intervention measures should be developed for different age and gender groups based on controllable risk factors, especially focusing on the elderly and male population.

Citation： GAO lingxiao, CAO Yuanyuan, TIAN Ruotong, DONG Xiaoyu, ZHANG Jiaqi, LYU Wenpei, CHENG Huaizhi, GUO Bin. Research on the trend of stroke burden in China from 1990 to 2021 and its age-period-cohort model. Chinese Journal of Evidence-Based Medicine, 2025, 25(7): 761-767. doi: 10.7507/1672-2531.202411020 Copy

1.	《中國腦卒中防治報告2021》編寫組. 《中國腦卒中防治報告2021》概要. 中國腦血管病雜志, 2023, 20(11): 783-793.
2.	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2100-2132.
3.	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990?2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol, 2021, 20(10): 795-820.
4.	Liu L, Liu J, Wang Y, et al. Substantial improvement of stroke care in China. Stroke, 2018, 49(12): 3085-3091.
5.	Tu WJ, Wang LD. China stroke surveillance report 2021. Mil Med Res, 2023, 10(1): 33.
6.	《中國卒中中心報告2022》概要. 中國腦血管病雜志, 2024, 21(8): 565-576.
7.	GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990?2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(5): 439-458.
8.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990?2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
9.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990?2019: a systematic analysis for the global burden of disease study 2019. Lancet, 2020, 396(10258): 1223-1249.
10.	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
11.	Luo L, Jiang J, Yu C, et al. Stroke mortality attributable to low fruit intake in China: a joinpoint and age-period-cohort analysis. Front Neurosci, 2020, 14: 552113.
12.	王越, 劉魯蓉. 1990?2019年中國老年人跌倒發生與死亡趨勢及其年齡-時期-隊列模型分析. 中國循證醫學雜志, 2024, 24(7): 783-791.
13.	World Health Organization. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2022.
14.	喬玥, 李傳輝, 趙文博. 急性缺血性腦卒中的再灌注治療的現狀與未來. 首都醫科大學學報, 2025, 46(1): 68-70.
15.	Chen D, Zhao Z, Zhang S, et al. Evolving Therapeutic landscape of intracerebral hemorrhage: emerging cutting-edge advancements in surgical robots, regenerative medicine, and neurorehabilitation techniques. Transl Stroke Res, 2024.
16.	閆潤楠. 腦卒中早期康復住院費用影響因素及病例組合研究. 北京: 北京協和醫學院, 2023.
17.	謝春艷, 王海銀, 王美鳳, 等. 基于價值的戰略購買: 健康中國背景下醫保治理的現代化轉向. 中國衛生事業管理, 2022, 39(5): 348-352.
18.	何峰, 何蓓蓓, 王仲朋, 等. 腦-機交互運動訓練的神經反饋方法及康復應用. 中國生物醫學工程學報, 2021, 40(6): 719-730.
19.	Murphy CC, Yang YC. Use of age-period-cohort analysis in cancer epidemiology research. Curr Epidemiol Rep, 2018, 5(4): 418-431.
20.	湯少梁, 趙興華, 董慧秋, 等. 中國、美國和全球居民2010?2019年腦卒中疾病, 負擔趨勢年齡–時期–隊列分析. 中國公共衛生, 2024, 40(6): 649-658.
21.	侯吉玉, 商黔惠, 劉風玲. 高血壓患者早期血管衰老防治的研究新進展. 中國老年學雜志, 2024, 44(18): 4591-4595.
22.	張雪莉, 呂恒梁, 胡夢夢, 等. 1990~2021年中國55歲及以上人群缺血性腦卒中疾病負擔及不良飲食危險因素變化趨勢. 中國老年學雜志, 2024, 44(21): 5340-5343.
23.	秦莉花, 黃娟, 李晟, 等. 腦卒中流行病學及與性激素的相關性. 中國老年學雜志, 2018, 38(20): 5099-5103.
24.	Roy-O'Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
25.	魏欣悅, 祖力亞爾·塔力甫, 鐘盼亮, 等. 1990?2019年中國60歲及以上老年人疾病負擔趨勢分析. 中華疾病控制雜志, 2024, 28(11): 1321-1329,1343.
26.	Tharmaratnam D, Karayiannis CC, Collyer TA, et al. Is blood pressure lowering in the very elderly with previous stroke associated with a higher risk of adverse events. J Am Heart Assoc, 2021, 10(24): e022240.
27.	秦靜, 周亞霖, 朱書平, 等. 城市社區老年人腦卒中患病狀況及健康管理. 中國老年學雜志, 2021, 41(8): 1730-1732.
28.	陳曉榮, 顏流霞, 厚磊, 等. 2015~2019年中國居民腦卒中發病與死亡特征分析. 中國循環雜志, 2024, 39(5): 470-476.
29.	Denny MC, Rosendale N, Gonzales NR, et al. Addressing disparities in acute stroke management and prognosis. J Am Heart Assoc. 2024, 13(7): e031313.
30.	Zeng C, Chen Z, Yang H, et al. Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke. Int J Biol Sci, 2022, 18(2): 552-571.
31.	張玉, 李詠梅, 陸慧萍, 等. 2002?2023年上海市松江區腦卒中疾病負擔變化分析. 中國慢性病預防與控制, 2024, 32(9): 717-720.
32.	GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990?2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1923-1994.
33.	Bell S, Sahm JL, Moriarty F, et al. Medication adherence for people with acquired communication disorders: a systematic review. Br J Clin Pharmacol, 2024, 90(11): 2742-2753.
34.	夏達建, 謝云芳, 張冬梅, 等. 1982?2021年中國缺血性腦卒中死亡趨勢及年齡-時期-隊列效應分析. 現代預防醫學, 2025, 52(4): 590-596,607.
35.	曾媛媛, 朱其鳳, 張永全. 缺血性腦卒中與相關信號通路的關系及中醫藥調控的研究進展. 中國實驗方劑學雜志, 2024, 30(20): 252-263.
36.	魯君, 張歸玲, 朱文珍. 人工智能在缺血性腦卒中影像中的應用進展. 中國醫學影像學雜志, 2022, 30(4): 396-400.
37.	李超, 楊輝. 腦卒中病人出院準備度循證干預方案臨床應用效果評價. 護理研究, 2022, 36(12): 2101-2106.
38.	吳瓊, 王晨冉, 趙燕, 等. 1990?2019年中國卒中危險因素的歸因負擔及變化趨勢. 中華疾病控制雜志, 2022, 26(1): 28-33, 79.
39.	Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122-135.
40.	Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 2019, 92: 98-107.
41.	王維國, 付嘉為, 范丹. 清潔能源發展的健康效應—以西氣東輸工程為例. 數量經濟技術經濟研究, 2024, 41(10): 150-170.
42.	曹清明, 王蔚婕, 張琳, 等. 中國居民平衡膳食模式的踐行—《中國居民膳食指南(2022)》解讀. 食品與機械, 2022, 38(6): 22-29.
43.	聶祖嬌, 鄭聰毅, 王馨, 等. 健康社會決定因素水平與腦卒中發病風險的關系—一項基于全國前瞻性隊列的研究. 中國循環雜志, 2024, 39(6): 599-605.

1. 《中國腦卒中防治報告2021》編寫組. 《中國腦卒中防治報告2021》概要. 中國腦血管病雜志, 2023, 20(11): 783-793.
2. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2100-2132.
3. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990?2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol, 2021, 20(10): 795-820.
4. Liu L, Liu J, Wang Y, et al. Substantial improvement of stroke care in China. Stroke, 2018, 49(12): 3085-3091.
5. Tu WJ, Wang LD. China stroke surveillance report 2021. Mil Med Res, 2023, 10(1): 33.
6. 《中國卒中中心報告2022》概要. 中國腦血管病雜志, 2024, 21(8): 565-576.
7. GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990?2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(5): 439-458.
8. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990?2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
9. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990?2019: a systematic analysis for the global burden of disease study 2019. Lancet, 2020, 396(10258): 1223-1249.
10. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
11. Luo L, Jiang J, Yu C, et al. Stroke mortality attributable to low fruit intake in China: a joinpoint and age-period-cohort analysis. Front Neurosci, 2020, 14: 552113.
12. 王越, 劉魯蓉. 1990?2019年中國老年人跌倒發生與死亡趨勢及其年齡-時期-隊列模型分析. 中國循證醫學雜志, 2024, 24(7): 783-791.
13. World Health Organization. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2022.
14. 喬玥, 李傳輝, 趙文博. 急性缺血性腦卒中的再灌注治療的現狀與未來. 首都醫科大學學報, 2025, 46(1): 68-70.
15. Chen D, Zhao Z, Zhang S, et al. Evolving Therapeutic landscape of intracerebral hemorrhage: emerging cutting-edge advancements in surgical robots, regenerative medicine, and neurorehabilitation techniques. Transl Stroke Res, 2024.
16. 閆潤楠. 腦卒中早期康復住院費用影響因素及病例組合研究. 北京: 北京協和醫學院, 2023.
17. 謝春艷, 王海銀, 王美鳳, 等. 基于價值的戰略購買: 健康中國背景下醫保治理的現代化轉向. 中國衛生事業管理, 2022, 39(5): 348-352.
18. 何峰, 何蓓蓓, 王仲朋, 等. 腦-機交互運動訓練的神經反饋方法及康復應用. 中國生物醫學工程學報, 2021, 40(6): 719-730.
19. Murphy CC, Yang YC. Use of age-period-cohort analysis in cancer epidemiology research. Curr Epidemiol Rep, 2018, 5(4): 418-431.
20. 湯少梁, 趙興華, 董慧秋, 等. 中國、美國和全球居民2010?2019年腦卒中疾病, 負擔趨勢年齡–時期–隊列分析. 中國公共衛生, 2024, 40(6): 649-658.
21. 侯吉玉, 商黔惠, 劉風玲. 高血壓患者早期血管衰老防治的研究新進展. 中國老年學雜志, 2024, 44(18): 4591-4595.
22. 張雪莉, 呂恒梁, 胡夢夢, 等. 1990~2021年中國55歲及以上人群缺血性腦卒中疾病負擔及不良飲食危險因素變化趨勢. 中國老年學雜志, 2024, 44(21): 5340-5343.
23. 秦莉花, 黃娟, 李晟, 等. 腦卒中流行病學及與性激素的相關性. 中國老年學雜志, 2018, 38(20): 5099-5103.
24. Roy-O'Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
25. 魏欣悅, 祖力亞爾·塔力甫, 鐘盼亮, 等. 1990?2019年中國60歲及以上老年人疾病負擔趨勢分析. 中華疾病控制雜志, 2024, 28(11): 1321-1329,1343.
26. Tharmaratnam D, Karayiannis CC, Collyer TA, et al. Is blood pressure lowering in the very elderly with previous stroke associated with a higher risk of adverse events. J Am Heart Assoc, 2021, 10(24): e022240.
27. 秦靜, 周亞霖, 朱書平, 等. 城市社區老年人腦卒中患病狀況及健康管理. 中國老年學雜志, 2021, 41(8): 1730-1732.
28. 陳曉榮, 顏流霞, 厚磊, 等. 2015~2019年中國居民腦卒中發病與死亡特征分析. 中國循環雜志, 2024, 39(5): 470-476.
29. Denny MC, Rosendale N, Gonzales NR, et al. Addressing disparities in acute stroke management and prognosis. J Am Heart Assoc. 2024, 13(7): e031313.
30. Zeng C, Chen Z, Yang H, et al. Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke. Int J Biol Sci, 2022, 18(2): 552-571.
31. 張玉, 李詠梅, 陸慧萍, 等. 2002?2023年上海市松江區腦卒中疾病負擔變化分析. 中國慢性病預防與控制, 2024, 32(9): 717-720.
32. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990?2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1923-1994.
33. Bell S, Sahm JL, Moriarty F, et al. Medication adherence for people with acquired communication disorders: a systematic review. Br J Clin Pharmacol, 2024, 90(11): 2742-2753.
34. 夏達建, 謝云芳, 張冬梅, 等. 1982?2021年中國缺血性腦卒中死亡趨勢及年齡-時期-隊列效應分析. 現代預防醫學, 2025, 52(4): 590-596,607.
35. 曾媛媛, 朱其鳳, 張永全. 缺血性腦卒中與相關信號通路的關系及中醫藥調控的研究進展. 中國實驗方劑學雜志, 2024, 30(20): 252-263.
36. 魯君, 張歸玲, 朱文珍. 人工智能在缺血性腦卒中影像中的應用進展. 中國醫學影像學雜志, 2022, 30(4): 396-400.
37. 李超, 楊輝. 腦卒中病人出院準備度循證干預方案臨床應用效果評價. 護理研究, 2022, 36(12): 2101-2106.
38. 吳瓊, 王晨冉, 趙燕, 等. 1990?2019年中國卒中危險因素的歸因負擔及變化趨勢. 中華疾病控制雜志, 2022, 26(1): 28-33, 79.
39. Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122-135.
40. Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 2019, 92: 98-107.
41. 王維國, 付嘉為, 范丹. 清潔能源發展的健康效應—以西氣東輸工程為例. 數量經濟技術經濟研究, 2024, 41(10): 150-170.
42. 曹清明, 王蔚婕, 張琳, 等. 中國居民平衡膳食模式的踐行—《中國居民膳食指南(2022)》解讀. 食品與機械, 2022, 38(6): 22-29.
43. 聶祖嬌, 鄭聰毅, 王馨, 等. 健康社會決定因素水平與腦卒中發病風險的關系—一項基于全國前瞻性隊列的研究. 中國循環雜志, 2024, 39(6): 599-605.

Chinese Journal of Evidence-Based Medicine

Research on the trend of stroke burden in China from 1990 to 2021 and its age-period-cohort model

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