The burden of ischemic stroke among middle-aged and older adults in China from 1990 to 2023 and future projections

Background: In China, ischemic stroke is a major cause of mortality and disability, with its disease burden remaining high due to accelerated population aging.This study aims to analyze trends in ischemic stroke burden among Chinese middle-aged and older adults from 1990 to 2023, quantify driving factors, and project future burden from 2024 to 2050 to inform prevention strategies. Methods: Data on prevalence, incidence, and disability-adjusted life years (DALYs) of ischemic stroke in Chinese middle-aged and older adults were extracted from the Global Burden of Disease Study (GBD) 2023 database.Joinpoint regression models and estimated annual percentage changes (EAPCs) were used to evaluate trends from 1990 to 2023.The age-period-cohort model analyzed the independent effects of disease risk.Demographic decomposition quantified contributions from population growth, aging, and epidemiological changes.The Bayesian age-period-cohort (BAPC) model projected burden trends for 2024-2050, validated by the ARIMA model.Attributable risk factors were analyzed based on the GBD framework.Results: From 1990 to 2023, the absolute burden of ischemic stroke increased significantly, with prevalent cases, incident cases, and DALYs rising by 240.14%, 227.11%, and 39.86%, respectively.Agestandardized prevalence (ASPR) and incidence rates (ASIR) increased, with EAPCs of 0.55 (95% CI: 0.52-0.58)and 0.06 (95% CI: -0.10-0.22).Conversely, age-standardized DALY rate (ASDALYR) decreased significantly (EAPC = -2.51,95% CI: -2.64 to -2.37).Decomposition analysis showed that population growth and aging were key drivers of increased prevalent cases.Age-Period-Cohort analysis revealed younger onset, with increasing risk in the middle-aged adults.Projections suggest prevalent cases will rise to 23.27 million by 2050, and incident cases will peak at 3.34 million in 2043, while ASDALYR continues to decline.High systolic blood pressure, high LDL cholesterol, and ambient particulate matter pollution were the top risk factors contributing to DALYs in 2023. Conclusions:The disease burden of ischemic stroke among Chinese middle-aged and older adults remains high.Despite medical advancements, the burden is projected to grow due to population aging.Prevention strategies must shift from solely managing older adults to a life-course approach, with earlier screening and intervention for metabolic risk factors such as hypertension and hyperlipidemia, and strengthening community-based prevention and control systems.