Objective To understand the changing trends of stroke burden among residents of China, the United States, and the world from 2010 to 2019, and to provide a reference for stroke prevention and control.

Methods Study data were collected from the Global Burden of Disease Study 2019 (GBD 2019) database. Descriptive analysis was performed using age-standardized rates of incidence, mortality, and disability-adjusted life years (DALY) of stroke. The Joinpoint regression model was used to analyze changing trends in stroke burden, and the age-period-cohort (APC) model was used to analyze age, period, and birth cohort effects on stroke burden.

Results From 2010 to 2019, the age-standardized rate (1/100 000) of stroke incidence among residents of China, the United States, and the world decreased from 201.06, 94.72, and 153.05 to 200.84, 86.96, and 150.77, with average annual percentage changes (AAPCs) of – 0.1%, – 0.8%, and – 0.2% and a significant decreasing trend in the United States and worldwide (both P < 0.05); the age-standardized rate (1/100 000) of stroke mortality decreased from 164. 90, 31.16, and 98.66 to 127.25, 30.76, and 84.19, with AAPCs of – 2.9%, – 0.2%, and – 1.8% and a significant decreasing trend in China and worldwide (both P < 0.001); and the age-standardized DALY rate (1/100 000) of stroke decreased from 3 018. 40, 734.77, and 2 048.37 to 2 412.52, 713.87, and 1 768.05, respectively, with AAPCs of – 2.5%, – 0.3%, and – 1.6% and a significant decreasing trend in China and worldwide (both P<0.001). The results of the APC model analysis showed that the net drift values of age-standardized incidence rates were >0 for both male and female residents of China, the United States, and the world, while the net drift values of age-standardized mortality rates were < 0. The relative risk (RR) of stroke incidence and mortality increased with age for residents of China, the United States, and the world; the RR of stroke incidence increased with period progression for residents of China, the United States, and the world, and the increase was greater for residents of the United States. In 2018, the period RR values of stroke incidence for male and female residents of the United States were 2.14 (95% confidence interval 95%CI: 1.45 – 3.16) and 2.18 (95%CI: 1.48 – 3.23), respectively. The RR of stroke mortality decreased with time for residents of China and the world, but the time RRs for stroke mortality were all > 1 for residents of the United States. The birth cohort-specific RR values for stroke incidence generally showed an increasing trend with time for residents of China and the United States, with a more pronounced increasing trend for residents of the United States. In 2014, the birth cohort-specific RR values for stroke incidence for male and female residents of the United States were 38.00 (95%CI: 6.08 – 237.32) and 43.07 (95%CI: 6.84 – 271.27), respectively, but the changing trend was not significant for the world population. The risk of stroke mortality showed a decreasing trend with increasing birth cohort among residents of China, with the birth cohort-specific RR value of stroke mortality for men ranging from 1.36 (95%CI: 1.31 – 1.41) to 0.51 (95%CI: 0.18 – 1.49), and the birth cohort-specific RR values of stroke mortality for female residents decreased continuously from 1.45 (95%CI: 1.41 – 1.47) to 0.40 (95%CI: 0.19 – 0.83), whereas the changing trends were not significant for residents of the United States and the world.

Conclusion The age-standardized rate of stroke mortality and DALYs among residents of China and the world decreased from 2010 to 2019, but the burden of stroke among residents of China was still higher than that of the global population. The stroke mortality rate among residents of the United States recently showed a slight increase, and age was an important determinant of stroke incidence and mortality.