ABSTRACT NUMBER: ESOC2026A426 AGE-SPECIFIC DIVERGENCE IN STROKE INCIDENCE IN CHINA: A SYSTEMATIC REVIEW, META-ANALYSIS AND HOSPITAL-BASED STUDY

Abstract Background and aims Stroke incidence is diverging by age in high-income countries with less favorable trajectories at younger ages. However, data are lacking in low-and-middle-income countries. We aimed to determine age-specific time trends in stroke incidence in China. Methods We searched PubMed, Web of Science, and the Chinese databases including CNKI, and Wanfang Data (inception to December 2024) for studies reporting age-specific stroke incidence across at least two time periods. We pooled the relative temporal trend ratio (RTTR) to compare trends at younger (<55y) versus older ages (≥55y). Using data from a hospital-based study (Shanghai Stroke Service System [4S] registry; 2018-2024), we calculated annual percentage change (APC) using Joinpoint regression. Results Of 43,552 records identified, 25 studies were included (502,601 strokes; ranging from 1984 to 2023). The pooled RTTR was 1.12 (95%CI 1.06-1.18), confirming divergence in time trends with a less favorable trend at younger ages. The divergence was broadly consistent by stroke subtype (ischaemic stroke: 1.21, 1.08-1.36; intracerebral hemorrhage: 1.15, 0.54-2.43) but appeared more marked in men than in women (men: 1.10, 0.98-1.23, women: 0.90, 0.76-1.07). Geographic variation was also evident, with a more pronounced divergence in urban than in rural areas (urban: 1.09, 1.01-1.18; rural: 0.98, 0.92-1.17). In Shanghai, stroke incidence also continued to diverge during 2018-2024 (RTTR = 1.51, 1.45-1.58) with an APC of 7.58% among those aged<55 years. Conclusions There is a significant and continuing divergence in stroke incidence trends in China, with a rising burden among younger adults, particularly in urban settings. This shift necessitates targeted stroke prevention strategies for younger populations. Conflict of interest Name of Nan Cao, Kun Fang, Ye Liu, Yanan Xie, Qiang Dong, Linxin Li, Xin Cheng nothing to disclose.