Stroke disability burden and rehabilitation service-capacity proxies in China, 1990–2023: A population-based analysis using GBD 2023 and national service statistics

China's stroke burden is increasingly shaped by survival with disability, population ageing, and demand for rehabilitation and long-term support. Yet the extent to which stroke disability burden has shifted towards older-old and oldest-old adults, and how this burden relates to community and elder-care service capacity, remains insufficiently quantified. We conducted a population-based secondary analysis of Global Burden of Disease Study 2023 estimates for China from 1990 to 2023, focusing on ischaemic stroke and intracerebral haemorrhage. We examined disability-adjusted life years (DALYs), years lived with disability (YLDs), YLD share of DALYs, age-specific patterns among adults aged 50 years or older, estimated annual percentage changes (EAPCs), and three-factor decomposition of absolute DALY changes. We also linked 2023 stroke YLDs with national community health and elder-care service indicators as descriptive capacity proxies. From 1990 to 2023, the YLD share of DALYs increased from 10.5% to 22.3% for ischaemic stroke and from 1.8% to 3.3% for intracerebral haemorrhage. The crude all-age ischaemic stroke YLD rate increased by 2.75% per year (95% CI 2.68 to 2.82), while the crude all-age intracerebral haemorrhage DALY rate declined but its YLD rate and YLD share increased. Crude all-age rates were interpreted as population-level burden indicators influenced by population age structure, alongside age-stratified and decomposition analyses. Among adults aged 50 years or older, disability burden shifted towards older-old and oldest-old groups, particularly for ischaemic stroke. In 2023, combined all-age YLDs from ischaemic stroke and intracerebral haemorrhage were approximately 4.77 million, corresponding descriptively to 128.2 YLDs per community health service centre/station and 16.7 YLDs per community health bed. Stroke in China is increasingly a survivorship and disability challenge. The burden-to-capacity proxy indicators provide planning context but do not directly measure rehabilitation access, adequacy, quality, or unmet need.