Epidemiology of ischemic stroke in China and the United States

Abstract

This study aimed to comprehensively compare the temporal trends, age–period–cohort (APC) effects, and future projections of ischemic stroke burden between China and the United States from 1990 to 2023. This cross-sectional, population-based retrospective study utilized data from the Global Burden of Disease 2023 database (PMID: 41092926). Data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for ischemic stroke were extracted for China and the United States from 1990 to 2023, stratified by sex and 19 age groups. Temporal trends were quantified using estimated annual percentage change (EAPC) through log-linear regression and average annual percentage change (AAPC) through joinpoint regression analysis. APC analysis using the intrinsic estimator method was performed to disentangle age, period, and cohort effects. Bayesian APC models with integrated nested Laplace approximation were employed to project disease burden through 2035. From 1990 to 2023, China demonstrated divergent trends with age-standardized incidence increasing by 5.41% (EAPC: 0.06%, 95% CI: −0.09 to 0.22%) and prevalence by 11.96% (EAPC: 0.44%, 95% CI: 0.41–0.46%), while mortality declined by 58.20% (EAPC: −2.68%, 95% CI: −2.84 to −2.51%) and DALYs by 54.99% (EAPC: −2.48%, 95% CI: −2.61 to −2.36%). The United States exhibited declining age-standardized rates across incidence (−27.17%, EAPC: −0.67%, 95% CI: −0.80 to −0.54%), mortality (−40.40%, EAPC: −2.00%, 95% CI: −2.33 to −1.67%), and DALYs (−28.49%, EAPC: −1.36%, 95% CI: −1.60 to −1.12%), with prevalence increasing by 10.93% (EAPC: 0.18%, 95% CI: 0.07–0.30%). Joinpoint analysis revealed heterogeneous patterns with multiple inflection points in both countries. APC analysis demonstrated exponential age effects, U-shaped period effects in China contrasting with declining then increasing patterns in the United States, and consistent cohort-related risk reductions in both nations. Projections to 2035 indicated that despite potential declines in age-standardized rates, absolute disease burden would escalate substantially: China’s incident cases projected to increase from 2656,475 to 4288,943 (61.46% increase), and the United States from 388,155 to 444,961 (14.64% increase). Despite improvements in age-standardized mortality and DALYs, both China and the United States face increases in absolute ischemic stroke burden through 2035 due to population aging, necessitating enhanced prevention strategies and healthcare resource allocation to address this intensifying public health challenge.