Projection of Stroke Incidence and Costs in China: 2022 to 2050

BACKGROUND: Stroke imposes a substantial and growing health and economic burden in China, yet forward-looking estimates of stroke-related costs remain scarce. METHODS: Annual age- and sex-specific incidence rates of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were projected from 2022 to 2050 using 2021 as the baseline year. Baseline incidence estimates were obtained from the Global Burden of Disease 2021 database, and future trends were projected using an exponential growth model parameterized by the average annual percent change estimated from 1990 to 2021 Global Burden of Disease data. Projected incidence rates were combined with China-specific population projections. A deterministic decision-tree model was used to estimate hospitalization costs, direct medical costs, and societal costs over a 12-month time horizon in China, using probabilities and unit costs from published literature. We used uncertainty intervals (UI) to quantify the plausible range of all projected outcomes. One-way sensitivity analyses were conducted to assess uncertainty in epidemiological and cost parameters. RESULTS: Total incident strokes are projected to increase from 4.35 million (95% UI, 3.09-5.89 million) in 2022 to 9.59 million (95% UI, 6.81-13.01 million) in 2050. By 2050, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidences are projected to reach 7.89, 1.59, and 0.11 million, respectively. Total annual stroke hospitalization costs are projected to rise from $46.1 billion (95% UI, 44.94-47.24 billion) in 2022 to $91.2 billion (95% UI, 89.28-93.13 billion) in 2050; direct medical costs and societal costs are projected to increase from $67.6 billion to $133.9 billion and from $145.6 billion to $288.4 billion, respectively. Costs will be increasingly concentrated among adults aged ≥65 years, especially those aged ≥85 years. In 2050, male stroke costs are projected to be ≈1.3× those for females. In sensitivity analyses incorporating incidence uncertainty, total annual hospitalization costs ranged from $39.9-$62.3 billion in 2022 to $65.0-$123.6 billion in 2050. CONCLUSIONS: Stroke incidence and costs in China are projected to increase through 2050, driven primarily by ischemic stroke and population aging, highlighting the need for targeted prevention, capacity planning for older adults, and long-term financing strategies.