Trends, Persistent Disability Burden, and Priority Risk Factors of Stroke in China from 1990 to 2023: Evidence from GBD 2023.

BACKGROUND: Stroke remains a major cause of death and disability in China. We assessed whether declining fatal burden was accompanied by improvement in non-fatal disability and characterized updated attributable risks. METHODS: Global Burden of Disease Study 2023 estimates for China during 1990-2023 were analyzed for age-standardized rates and all-age absolute numbers of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Stroke subtypes, age-sex patterns, Socio-demographic Index comparisons, risk-attributable fractions, and estimated annual percentage changes were evaluated. RESULTS: The age-standardized DALY rate decreased from 6099.97 to 1912.42 per 100,000 population (-68.6%), and the death rate decreased from 302.72 to 92.83 (-69.3%). All-age deaths were 2.05 million (95% UI, 1.70-2.40) in 1990 and 2.05 million (1.74-2.35) in 2023, whereas DALYs decreased from 49.21 million (40.63-57.77) to 42.69 million (37.53-47.86). YLL rates declined markedly but YLD rates changed little; the YLL/YLD ratio fell from 23.9 to 7.1. High systolic blood pressure was the leading 2023 risk factor for stroke DALYs (attributable fraction, 59.98%). CONCLUSIONS: Fatal stroke burden declined substantially, but non-fatal burden remained important. The lower YLL/YLD ratio mainly reflects a faster decline in YLLs and does not establish worsening disability among individual survivors. Prevention should combine blood pressure and metabolic risk control with stronger post-stroke rehabilitation.