Disease burden and prediction of stroke attributable to metabolic risk factors in China, 1990-2021_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Yao ^1,2 , LI Hui ^1,2 , ZHANG Xiaoyu ^1,2 , DUAN Mengli ^1,2 ,  YANG Min ^1,2

1. The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, P. R. China;
2. The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, P. R. China;

Corresponding author：

YANG Min, Email: yangmin@ahmu.edu.cn

Keywords：

Stroke; Metabolic risk factors; Disease burden

DOI：

10.7507/1672-2531.202504025

Video：

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Objective To analyze the burden and trend of stroke attributable to metabolic risk factors in China from 1990 to 2021. Methods Data on deaths and disability-adjusted life years (DALYs) attributed to metabolic risk factors for stroke were analyzed based on the Global Burden of Disease (GBD) database 2021 in China, globally, and across different socio-demographic index (SDI) regions from 1990 to 2021. Joinpoint regression analysis was utilized to calculate the average annual percent change (AAPC) to evaluate temporal trends in disease burden. Results In 2021, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of stroke attributable to metabolic risk factors in China were 93.57/100 000 and 1 793.16/100 000, respectively, both higher than global and all SDI regional averages. Among metabolic-related stroke subtypes, ischemic stroke accounted for the highest disease burden, whereas subarachnoid hemorrhage had the lowest. Disease burden was greater in men compared with women. Both stroke mortality and DALYs rate increased with advancing age, with DALYs rate slightly declined only after the age of 95 years. Elevated systolic blood pressure (SBP) was identified as the leading metabolic risk factors for stroke burden. Between 1990 and 2021, the ASMR (AAPC=−1.34) and ASDR (AAPC=−1.38) attributed to metabolic risk factors of stroke in China showed decreasing trends, consistent with global and regional SDI averages, with greater reductions observed in women. Declining trends were also observed across all stroke subtypes, only stroke burden associated with high body mass index (BMI) exhibited an increasing trend. By 2031, the ASMR and ASDR are projected to decrease to 77.37/100 000 and 1 478.88/100 000, respectively. Conclusion From 1990 to 2021, the burden of stroke attributable to metabolic risk factors in China showed an overall declining trend. However, the burden remained higher compared with global and regions SDI levels, particularly among men and older adults. Future efforts should focus on enhancing metabolic factors screening and management in high-risk populations, along with optimizing individualized interventions to further reduce stroke burden.

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31.	Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ, 1994, 72: 429-445.
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33.	Qi W, Ma J, Guan T, et al. Risk factors for incident stroke and its subtypes in China: a prospective study. J Am Heart Assoc, 2020, 9(21): e016352.
34.	Zhou XD, Chen QF, Targher G, et al. Global burden of disease attributable to metabolic risk factors in adolescents and young adults aged 15-39, 1990-2021. Clinical Nutrition, 2024, 43: 391-404.
35.	Ohlsson C, Bygdell M, Sondén A, et al. BMI increase through puberty and adolescence is associated with risk of adult stroke. Neurology, 2017, 89(4): 363-369.
36.	Huo RR, Zhai L, Liao Q, et al. Changes in the triglyceride glucose-body mass index estimate the risk of stroke in middle-aged and older Chinese adults: a nationwide prospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 254.
37.	Miwa K, Nakai M, Yoshimura S, et al. Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes. Int J Stroke, 2024, 19(8): 907-915.
38.	Lovren F, Teoh H, Verma S. Obesity and atherosclerosis: mechanistic insights. Can J Cardiol, 2015, 31(2): 177-183.
39.	向凤, 曹学华, 胡婉琴, 等. 超重肥胖儿童非酒精性脂肪性肝病患病率及影响因素的Meta分析. 数理医药学杂志, 2024, 37(12): 935-946.
40.	中国居民营养与慢性病状况报告(2020年). 营养学报, 2020, 42(6): 521.

1. Hilkens NA, Casolla B, Leung TW, et al. Stroke. Lancet, 2024, 403(10446): 2820-2836.
2. World Health Organization. Global health estimates: life expectancy and leading causes of death and disability.
3. Ma Q, Li R, Wang L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health, 2021, 6(12): e897-e906.
4. 王仕鸿, 赖凤霞, 张之怡, 等. 2020—2040年中国缺血性脑卒中流行趋势预测. 中国神经免疫学和神经病学杂志, 2024, 31: 459-467.
5. Caprio FZ, Sorond FA. Cerebrovascular disease: primary and secondary stroke prevention. Med Clin North Am, 2019, 103(2): 295-308.
6. Barthels D, Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis, 2020, 1866(4): 165260.
7. Tune JD, Goodwill AG, Sassoon DJ, et al. Cardiovascular consequences of metabolic syndrome. Transl Res, 2017, 183: 57-70.
8. Zhang H, Zhou XD, Shapiro MD, et al. Global burden of metabolic diseases, 1990-2021. Metabolism, 2024, 160: 155999.
9. Ji C, Ge X, Zhang J, et al. The stroke burden in china and its long-term trends: insights from the Global Burden of Disease (GBD) Study 1990-2021. Nutr Metab Cardiovasc Dis, 2025, 35(7): 103848.
10. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
11. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2162-2203.
12. GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol, 2024, 23(10): 973-1003.
13. GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1160-1203.
14. 宇传华, 白建军. 社会人口指数(SDI)的概念及其应用. 公共卫生与预防医学, 2020, 31: 5-10.
15. Wei J, Chen L, Huang S, et al. Time trends in the incidence of spinal pain in China, 1990 to 2019 and its prediction to 2030: the Global Burden of Disease Study 2019. Pain Ther, 2022, 11(4): 1245-1266.
16. Zheng A, Fang Q, Zhu Y, et al. An application of ARIMA model for predicting total health expenditure in China from 1978-2022. J Glob Health, 2020, 10(1): 010803.
17. Lin X, Wang H, Rong X, et al. Exploring stroke risk and prevention in China: insights from an outlier. Aging (Albany NY), 2021, 13(11): 15659-15673.
18. Wang W, Wang D, Liu H, et al. Trend of declining stroke mortality in China: reasons and analysis. Stroke Vasc Neurol, 2017, 2(3): 132-139.
19. 中华人民共和国中央人民政府. 中共中央国务院印发《“健康中国2030”规划纲要》. 2016.
20. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
21. Tu WJ, Zhao Z, Yin P, et al. Estimated burden of stroke in China in 2020. JAMA Netw Open, 2023, 6(3): e231455.
22. 国家心血管病中心, 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2023概要. 中国循环杂志, 2024, 39(7): 625-660.
23. Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol, 2020, 75(15): 1804-1818.
24. Niu R, Wang H, Peng R, et al. Associations of plasma metabolites with risks of incident stroke and its subtypes in Chinese adults. J Am Heart Assoc, 2024, 13(12): e033201.
25. Vojinovic D, Kalaoja M, Trompet S, et al. Association of circulating metabolites in plasma or serum and risk of stroke: meta-analysis from 7 prospective cohorts. Neurology, 2021, 96(8): e1110-e1123.
26. Holmes MV, Millwood IY, Kartsonaki C, et al. Lipids, lipoproteins, and metabolites and risk of myocardial infarction and stroke. J Am Coll Cardiol, 2018, 71(6): 620-632.
27. Alonso de Leciñana M, Egido JA, Fernández C, et al. Risk of ischemic stroke and lifetime estrogen exposure. Neurology, 2007, 68(1): 33-38.
28. Ye Y, Zhou Q, Dai W, et al. Gender differences in metabolic syndrome and its components in southern China using a healthy lifestyle index: a cross-sectional study. BMC Public Health, 2023, 23(1): 686.
29. Tramunt B, Smati S, Grandgeorge N, et al. Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia, 2020, 63(3): 453-461.
30. Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life. JAMA, 2003, 289(18): 2387-2392.
31. Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ, 1994, 72: 429-445.
32. Smith CJ, Lawrence CB, Rodriguez-Grande B, et al. The immune system in stroke: clinical challenges and their translation to experimental research. J Neuroimmune Pharmacol, 2013, 8(4): 867-887.
33. Qi W, Ma J, Guan T, et al. Risk factors for incident stroke and its subtypes in China: a prospective study. J Am Heart Assoc, 2020, 9(21): e016352.
34. Zhou XD, Chen QF, Targher G, et al. Global burden of disease attributable to metabolic risk factors in adolescents and young adults aged 15-39, 1990-2021. Clinical Nutrition, 2024, 43: 391-404.
35. Ohlsson C, Bygdell M, Sondén A, et al. BMI increase through puberty and adolescence is associated with risk of adult stroke. Neurology, 2017, 89(4): 363-369.
36. Huo RR, Zhai L, Liao Q, et al. Changes in the triglyceride glucose-body mass index estimate the risk of stroke in middle-aged and older Chinese adults: a nationwide prospective cohort study. Cardiovasc Diabetol, 2023, 22(1): 254.
37. Miwa K, Nakai M, Yoshimura S, et al. Clinical impact of body mass index on outcomes of ischemic and hemorrhagic strokes. Int J Stroke, 2024, 19(8): 907-915.
38. Lovren F, Teoh H, Verma S. Obesity and atherosclerosis: mechanistic insights. Can J Cardiol, 2015, 31(2): 177-183.
39. 向凤, 曹学华, 胡婉琴, 等. 超重肥胖儿童非酒精性脂肪性肝病患病率及影响因素的Meta分析. 数理医药学杂志, 2024, 37(12): 935-946.
40. 中国居民营养与慢性病状况报告(2020年). 营养学报, 2020, 42(6): 521.

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