Chen Rongrong, Li Xiangwen, Zhao Ruonan, Zhao Xufei, Ma Lin, Miao Qi, Zhang Rongqiang
School of Public Health, Shaanxi University of Chinese Medicine, Shaanxi, 712046, Xianyang, P. R. China.
Affiliated Hospital, Shaanxi University of Chinese Medicine, Shaanxi, 712000, Xianyang, P. R. China.
Neurol Sci. 2025 Sep 8. doi: 10.1007/s10072-025-08465-4.
Stroke persists as the second leading global cause of mortality and disability. We analyzed G20 nations using Global Burden of Disease (GBD) 2021 data (1990-2021) to provide a new perspective.
We obtained age-standardized rates (ASR) of stroke mortality, incidence, prevalence, and YLLs (years of life lost) across G20 nations. Attributable risks identified key factors, decomposition analysis explored epidemiological drivers, and inequality analysis assessed socioeconomic disparities. Bayesian age-period-cohort (BAPC) modeling projected trends to 2035.
In 2021, stroke was the second leading cause of level 3 mortality in the G20 countries, accounting for 11.83% (95% UI:10.75-12.59) of total deaths, and the leading cause of level 3 mortality in China and Indonesia. In 2021, stroke caused 5.27 million (4.67-5.78) deaths in the G20 countries, with 8.74 million (7.80-9.77) new cases and 67.82 million (63.67-72.51) prevalent cases, the years of life lost (YLLs) totaled 100.63 million (91.46-110.31). China had the highest absolute burden; Indonesia showed the highest ASMR (Age-standardized mortality rates), ASIR (Age-standardized incidence rates), ASPR (age-standardized prevalence rates), and ASYR (age-standardized years of life lost), South Korea had the steepest ASR declines. High systolic blood pressure and air pollution were primary risk factors. Projections reveal Indonesia's rapid ASR declines contrasting with China's rising prevalence among adults ≥ 75 years and growing case numbers in aging populations.
While stroke ASR decreased significantly since 1990, substantial cross-country disparities persist, linked to socioeconomic development. Absolute burden will increase with aging populations, necessitating targeted interventions against hypertension, air pollution, and elderly healthcare gaps.
中风仍然是全球第二大致死和致残原因。我们利用《2021年全球疾病负担》（GBD 2021）数据（1990 - 2021年）对二十国集团（G20）国家进行分析，以提供新的视角。
我们获取了G20国家中风死亡率、发病率、患病率和寿命损失年数（YLLs）的年龄标准化率（ASR）。归因风险确定关键因素，分解分析探究流行病学驱动因素，不平等分析评估社会经济差异。贝叶斯年龄 - 时期 - 队列（BAPC）模型预测了到2035年的趋势。
2021年，中风是G20国家三级死亡率的第二大原因，占总死亡人数的11.83%（95% UI：10.75 - 12.59），是中国和印度尼西亚三级死亡率的首要原因。2021年，中风在G20国家导致527万（467 - 578）人死亡，有874万（780 - 977）例新发病例和6782万（6367 - 7251）例现患病例，寿命损失年数总计1.0063亿（9146 - 1.1031亿）。中国的绝对负担最高；印度尼西亚的年龄标准化死亡率（ASMR）、年龄标准化发病率（ASIR）、年龄标准化患病率（ASPR）和年龄标准化寿命损失年数（ASYR）最高，韩国的年龄标准化率下降最为显著。收缩压升高和空气污染是主要风险因素。预测显示，印度尼西亚的年龄标准化率迅速下降，而中国≥75岁成年人中的患病率上升，老年人口中的病例数不断增加。
虽然自1990年以来中风的年龄标准化率显著下降，但国家间仍存在巨大差异，这与社会经济发展有关。随着人口老龄化，绝对负担将增加，因此有必要针对高血压、空气污染和老年医疗保健差距进行有针对性的干预。
