Objective  To analyze the spatial and temporal distribution characteristics and age-period-cohort effects of ischemic stroke disease burden in China and globally from 1990 to 2021, and forecast the  ischemic stroke disease burden in China and globally from 2022 to 2035, in order to provide scientific basis for formulating and adjusting prevention and control strategies.

Methods  Global Burden of Disease Study 2021 (GBD 2021) and Bayesian age-period-cohort (BAPC) model of R 4.4.2 software were used to analyze time trends in incidence, mortality, and disability-adjusted life years (DALYs) of ischemic stroke in China and globally from 1990 to 2021, and projected disease burden trends from 2022 to 2035.

Results  The standardized incidence of ischemic stroke in China increased from 100.05/100 000 in 1990 to 135.79/100 000, with an increase rate of 35.7% (average annual percent change, AAPC=0.967 7, 95%CI: 0.933 1 to 1.002 2, P<0.01). The standardized mortality decreased from 75.22 per 100 000 in 1990 to 64.47 per 100 000, with a reduction rate of 14.3% (AAPC=-0.486 7, 95%CI: -0.747  2 to -0.225 6, P<0.01). The standardized incidence of ischemic stroke globally decreased from 109.79/100 000 in 1990 to 92.39/100 000, with a reduction rate of 15.8% (AAPC=- 0.567 3, 95%CI: -0.654 5 to -0.480 0, P<0.01). The standardized mortality decreased from 73.15 per 100 000 in 1990 to 44.18 per 100 000, with a reduction of 39.6% (AAPC=-1.602 1, 95%CI: -1.809 6 to -1.394 2, P<0.01). The standardized DALYs rate in China decreased by 14.91% (from 1 387.93/100 000 to 1 180.98/100 000), and the global standardized DALYs rate decreased by 34.90% (from 1  286.31/100 000 to 837.36/100 000). It is predicted that by 2035, the standardized incidence of ischemic stroke globally will rise to 100.51 per 100 000, and the standardized mortality will drop to 39.53 per 100 000. In China, the standardized incidence of ischemic stroke will rise to 168.52 per 100 000, and the standardized mortality will drop to 52.51 per 100 000.

Conclusion  The standardized incidence of ischemic stroke globally and in China shows a significant "reverse trend". Although both the standardized mortality and standardized DALYs rate have shown a downward trend, the decline rates are significantly different. The decline rate in China is smaller than that globally, forming a "divergent difference". It is necessary to be vigilant about the long-term burden brought by population aging and the risk of lagging prevention and control measures. In the future, chronic disease screening and community health management among the elderly population in China should be strengthened. At the same time, the localization of international experiences (such as the standardization of stroke units) should be promoted to narrow the global disease burden gap and address the challenges of ischemic stroke prevention and control in the context of aging.

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