Burden of Stroke and Its Subtypes in Young Adults in China: A Systematic Analysis from 1990 to 2023 and Projections to 2050.

Introduction Stroke is a major global public health problem. The rising incidence among young adults (15-49 years) represents a critical challenge, especially in China. We analyzed epidemiological trends, burden drivers, risk factors, and future projections of stroke and its three subtypes in young adults globally and in China from 1990 to 2023. Methods Data were derived from the 2023 Global Burden of Disease study. Age-standardized rates, annual changes, age-period-cohort analysis, decomposition analysis, Bayesian forecasting to 2050, and risk assessment were performed. Results Global and Chinese overall stroke age-standardized incidence rates declined, but new cases increased globally, and ischemic stroke age-standardized incidence rose significantly in China. China's proportion of global cases and deaths decreased. Males had higher rates than females in China. Aging and population growth increased stroke burden. High systolic blood pressure, smoking, and air pollution were the leading risk factors. Age-standardized incidence rates will rise by 2050, while mortality and disability rates will fall except in young females globally. Conclusions Young adult stroke exhibited dual epidemiological trends globally and in China. The rising ischemic stroke incidence among young Chinese adults, notable gender disparities, and dominant modifiable risk factors highlight important public health implications. Targeted, gender-stratified prevention strategies and optimized healthcare planning are urgently needed to mitigate the future stroke burden, particularly for high-risk young populations.