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Dementia and Cognitive Impairment Research / Acute Ischemic Stroke Management · Journal article
Medicine · August 14, 2026
Well-designed and adequately powered for the question it asks.
This population-based epidemiological study comparing ischemic stroke burden in China and the United States from 1990–2023 reveals divergent temporal patterns: China shows rising incidence and prevalence despite declining mortality, while the United States demonstrates declining incidence and mortality with rising prevalence. Despite improvements in age-standardized metrics, both nations face substantial increases in absolute disease burden by 2035 due to demographic aging, indicating intensifying public health demands.
Cross-sectional, population-based retrospective study with temporal trend analysis and projection modelling. Population-based data from China and the United States covering 1990–2023, stratified by sex and 19 age groups. Compared with: China versus United States. China and the United States.
China: age-standardized incidence increased 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%) from 1990–2023 China: mortality declined 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%) over same period United States: age-standardized incidence declined 27.17% (EAPC: −0.67%, 95% CI: −0.80 to −0.54%) and mortality by 40.40% (EAPC: −2.00%, 95% CI: −2.33 to −1.67%)
China: mortality declined 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%) over same period United States: age-standardized incidence declined 27.17% (EAPC: −0.67%, 95% CI: −0.80 to −0.54%) and mortality by 40.40% (EAPC: −2.00%, 95% CI: −2.33 to −1.67%)
Clinicians and public health professionals should recognize divergent epidemiological patterns between nations: China faces rising stroke incidence despite mortality improvements, requiring intensive primary prevention; both nations will experience marked absolute burden increases by 2035 despite favourable age-standardized trends, necessitating resource planning and health system adaptation.
Rigorous population-based retrospective analysis using Global Burden of Disease data with sophisticated temporal trend analysis and projections, providing clear epidemiological comparisons across two major countries, though descriptive rather than causal or interventional.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and public health professionals should recognize divergent epidemiological patterns between nations: China faces rising stroke incidence despite mortality improvements, requiring intensive primary prevention; both nations will experience marked absolute burden increases by 2035 despite favourable age-standardized trends, necessitating resource planning and health system adaptation.
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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.
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