Abstract:

In 2021, there were 93.816 million prevalent cases of stroke worldwide [age-standardized prevalence rate(ASPR) 1 099/100 000], with 11.946 million new cases in that year [age-standardized incidence rate(ASIR) 142/100 000]. Among these new cases, ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) accounted for 65.3% (7.804 million), 28.8% (3.444 million), and 5.8% (0.697 million), respectively. In the same year, stroke caused 7.253 million deaths, accounting for 10.7% of all global deaths. Deaths caused by IS, ICH, and SAH accounted for 49.5% (3.591 million), 45.6% (3.308 million), and 4.9% (353 000), respectively. In 2021, stroke remained the second leading cause of death worldwide, with its core disease burden indicator — disability-adjusted life years (DALYs) — exceeding 160 million, ranking third among all global total disease burdens. In terms of economic burden, the global direct medical costs and productivity losses caused by stroke reached 890 billion USD in 2021 (accounting for 0.66% of the global GDP), and are projected to exceed 1.8 trillion USD by 2050 if the current growth rate persists. The global stroke burden exhibits a dual trend of "increasing absolute numbers but decreasing age-standardized rates". Low- and middle-income countries bear most of the disease burden, and the incidence of stroke shows a coexistence of younger and older onset. In terms of risk factors, the burden of traditional behavior-related risks has decreased, while the attributable burden of metabolic and climate-related risks is rapidly increasing. China bears the heaviest stroke burden globally, characterized by a “four-high” pattern of “high incidence, high prevalence, medium-to-high mortality, and medium-to-high DALYs”, with significant urban-rural and regional disparities. This condition results from the combined effects of accelerated population aging and continuously increasing exposure to risk factors. In 2021, there were 26.335 million prevalent cases in China, with ASPR of 1 301.4/100 000. In 2021, there were 4.09 million new stroke cases in China (ASIR 204.8/100 000), accounting for 34.2% of all new global cases—far exceeding China's proportion of the world's population (about 20%). IS accounted for 67.8% [2.772 million cases, age-standardized incidence rate (ASIR) 135.8/100 000], and ICH accounted for 28.7% (1.173 million cases, ASIR 61.2/100 000). The annual total economic burden of stroke in China has exceeded 400 billion RMB, with its proportion in the national healthcare expenditure continuing to increase. Direct medical costs account for about 60%, while indirect costs (including productivity losses and caregiving expenses) account for 40%, imposing a dual pressure on both society and families. To address this challenge, a stratified precision prevention and control system centered on the coordination of "policy-healthcare-society" should be established, covering primordial, primary, and secondary prevention levels. Emphasis should be placed on cross-sector collaboration, data-driven approaches, and international experience sharing to achieve effective control of the stroke burden and promote global health equity.

Key words: Stroke, Disease burden, Risk factors, Prevention and control strategies