Yijun Zhang, Jinqiao Zhu, Xue Xia, Meng Gao, Yunyi Hao, Anxin Wang
The IS burden is expected to continue increasing through 2050 albeit at a slower rate. Notably, the ASIR of IS will increase faster in females than in males from 2021 to 2050. Technological innovation, effective policies, and more health spending are needed to curb this increase.
BACKGROUND: Comprehensive understanding of the ischemic stroke (IS) burden in China is critical for policy and medical resource allocation. We aimed to identify the most up-to-date IS burden by age- and sex-specific temporal trends in China and forecast to 2050.
METHODS: Based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, we investigated the IS burden in China from 1990 to 2021. IS incidence and mortality data were extracted by age and sex. Temporal trends were assessed using joinpoint regression to calculate average annual percentage changes (AAPCs). The Auto-regressive Integrated Moving Average (ARIMA) models, incorporating Socio-demographic Index and proportion of population aged >65 years as external predictors, were used to forecast the IS burden in China from 2022 to 2050. Decomposition analysis was performed to quantify the contributions of population growth, aging, and epidemiological changes to the observed and projected burden shifts.
RESULTS: From 1990 to 2021, the age-standardized incidence rate (ASIR) of IS increased (AAPC: 0.97%, 95% confidence interval [CI] 0.93-1.00); whereas the age-standardized mortality rate (ASMR) decreased (AAPC: -0.49%, 95% CI -0.75 to -0.23). The ASIR increased faster (AAPC: 1.13% vs. 0.72%) and ASMR decreased slower in males than in females (AAPC: -0.14% vs. -0.89%) between 1990 and 2021. From 2021 to 2050, the ASIR will increase slower (AAPC: 0.77%; 95% CI 0.75-0.79) and the ASMR will decrease faster (AAPC: -1.53%; 95% CI -1.56 to -1.51). The ASIR will increase more pronounced in females (AAPC: 1.04%, 95% CI 1.02-1.07) than in males (AAPC: 0.56%, 95% CI 0.56-0.57) between 2021 and 2050. By 2050, those over 85 years old will have the highest incidence and mortality, the number of IS incident cases and deaths will reach 3.68 million (95% uncertainty interval [UI] 3.05-4.40) and 1.50 million (95% UI 1.27-1.76). The predominant factor leading to the growth of IS incident cases (54.04%) and deaths (73.2%) between 2021 and 2050 will be shifted to aging.
CONCLUSIONS: The IS burden is expected to continue increasing through 2050 albeit at a slower rate. Notably, the ASIR of IS will increase faster in females than in males from 2021 to 2050. Technological innovation, effective policies, and more health spending are needed to curb this increase.