Objective  To examine incidence and mortality trends of ischemic stroke (IS) among Chinese residents from 1990 to 2019 and to provide a reference for the prevention and control of IS in China.

  Methods  The data on IS incidence and mortality among Chinese residents from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression model was used to analyze changing trend of IS incidence and mortality. The age-period-cohort (APC) model was used to assess the effects of age, period, and birth cohort on the risk of IS incidence and mortality.

  Results  The crude incidence rate (per 100 000 population) of IS increased from 74.26 in 1990 to 201.74 in 2019 for all Chinese residents; and the rate increased from 64.58 to 183.60 for the male residents and from 84.55 to 220.59 for the female residents. The standardized incidence rate (per 100 000 population) of IS also increased from 107.49 in 1990 to 144.78 in 2019 for all Chinese residents; for male and female residents, the standardized incidence rate increased from 101.14 and 113.72 to 141.10 and 149.44, respectively. During 30-year period, the average annual percentage change (AAPC) in standardized IS incidence rate for all, male and female Chinese residents were 1.04%, 1.16% and 0.94% (all P < 0.001). The crude IS mortality rate (per 100 000 population) for all, male and female Chinese residents increased from 32.08, 32.09 and 32.06 in 1990 to 72.37, 79.89 and 64.55 in 2019; the standardized IS mortality rate (per 100 000 population) for all and female Chinese residents decreased from 64.32 and 56.13 in 1990 to 62.18 and 48.26 in 2019; but the standardized IS mortality rate for male Chinese residents increased from 77.34 in1990 to 83.55 in 2019. During 30-year period, the AAPC in standardized IS mortality rate for all, male and female Chinese residents were – 0.12% (P = 0.463), 0.29% and – 0.50% (both P < 0.05). The results of the APC model analysis showed that the local drift values of IS incidence rate for male residents aged 35 – 89 years and female residents aged 45 – 89 years were greater than 0, and the local drift values of IS mortality rate for male residents aged 75 – 94 years were greater than 0. The longitudinal curve for age-specific IS incidence and mortality for both male and female residents in the same birth cohort showed an increasing trend. The IS risk of male residents remained stable in each period group from 1990 to 2004, then increased slowly from 2005 to 2009, and rapidly increased in each period group from 2010 to 2019. The IS risk of the female residents decreased in each period group from 1990 to 2004, and increased slowly from 2005 to 2009; from 2010 to 2014, the risk increased rapidly, and from 2015 to 2019, the increasing trend was very smooth and almost remained stable. From 1990 to 2019, the IS mortality risk of male and female Chinese residents showed a downward trend over the time period and the mortality risk reached the minimum from 2015 to 2019. From 1990 to 2019, the IS risk of male and female Chinese residents increased first and then decreased with the birth cohort. The peak of the birth cohort effect on IS in male residents occurred from 1973 to 1977, and that in female residents occurred from 1958 to 1962. The IS mortality risk in male and female Chinese residents from 1990 to 2019 showed an overall downward trend along with the birth cohort.

  Conclusion  The incidence of ischemic stroke in Chinese residents showed an increasing trend from 1990 to 2019. Age, period, and birth cohort effect have a certain influence on the risk of ischemic stroke with gender disparity. Although the period and cohort effect on IS mortality risk showed a decline trend, the continuous increasing age effect made the actual burden of IS mortality much heavier among Chinese residents, especially among elderly male residents.