Burden of stroke in China: A decomposition analysis investigating the driven factors

Background: While the degree of population aging is increasing, a nationwide stroke program was started in 2011. We analyzed how population aging outpaced gains in stroke care in China. Methods: The number of deaths, incidence, prevalence, Disability-Adjusted Life Years (DALYs) attributable to stroke and its subtypes from 2012 to 2021 were extracted from the Global Health Data Exchange database. The total populations of age groups in 2012 and 2021 were extracted from the National Bureau of Statistics of China. The Das Gupta Decomposition method was applied to identify the contributions of population growth, population aging, and the changes in the incidence, mortality, prevalence, and DALYs. Result: From 2012-2021, the total stroke incidence increased by 38.4 % (from 2.95 to 4.09 million), deaths by 17.6 % (from 2.20 to 2.59 million), and prevalence by 34.2 % (from 19.62 to 26.34 million) in China. Decomposition analysis identified rapid population aging as the predominant driver, accounting for 78.1 % of the incidence increase and even exceeding the total death increase (197.6 %), overwhelming the benefits from improved stroke care. The stroke subtype profile shifted markedly, with ischemic stroke's share of incidence rising from 62 % to 68 % and deaths from 41 % to 46 %, while intracerebral hemorrhage's contribution declined. Conclusion: The escalating stroke burden in China is primarily driven by population aging, followed by population growth, creating a paradox where healthcare improvements are offset demographically. The epidemic is increasingly characterized by ischemic stroke, leading to a growing population of survivors requiring long-term care. This necessitates a paradigm shift in health policy from a focus solely on reducing acute mortality towards building cost-effective, integrated systems for lifelong stroke management, chronic care, and secondary prevention tailored for an aging society.