Objective To analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019, and to provide a scientific basis for formulating targeted stroke prevention and control strategies.

Methods Data on the burden of stroke among Chinese residents in 1990, 2000, 2010, and 2019 were collected from the 2019 Global Burden of Disease Study (GBD 2019). Indicators such as disability-adjusted life years (DALYs), DALY rates, and population attributable fractions (PAFs) were used to analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019.

Results In 2019, the DALY rates of stroke, ischemic stroke, and hemorrhagic stroke among Chinese residents increased with age, with the highest rates observed in the ≥70 age group (21 061.26/100 000, 11 858.11/100 000, and 8 505.17/100 000, respectively). The DALY rates of stroke, ischemic stroke, and hemorrhagic stroke were higher in men (3 739.30/100 000, 1 627.23/100 000, and 1 924.07/100 000, respectively) than in women (2 701.81/100 000, 1 376.19/100 000, and 1 184.82/100 000, respectively). From 1990 to 2019, the DALY rates of stroke and ischemic stroke increased (with average annual growth rates of 0.44% and 2.39%, respectively), while the DALY rate of hemorrhagic stroke decreased (with an average annual growth rate of –0.08%). In 2019, the top three risk factors for stroke in terms of DALYs, PAFs, and DALY rates were high systolic blood pressure (251763 million person-years, 54.80%, and 1 770.05/100 000, respectively), ambient air pollution (128473 million person-years, 27.95%, and 903.24/100 000, respectively), and smoking (10.099 3 million person-years, 21.96%, and 710.04/100 000, respectively). The top three risk factors for ischemic stroke were high systolic blood pressure (10.896 8 million person-years, 50.94%, and 766.11/100 000, respectively), ambient air pollution (5.737 8 million person-years, 26.81%, and 403.40/100 000, respectively), and high LDL cholesterol (4.427 7 million person-years, 20.69%, and 311.29/100 000, respectively). The top three risk factors for hemorrhagic stroke were high systolic blood pressure (12.919 0 million person-years, 58.18%, and 908.28/100 000, respectively), ambient air pollution (6.403 9 million person-years, 28.82%, and 450.23/100 000, respectively), and high-sodium diet (5.421 3 million person-years, 24.40%, and 381.15/100 000, respectively). From 1990 to 2019, the PAFs of eight risk factors for stroke increased and two decreased, six risk factors for ischemic stroke increased and four decreased, and eight risk factors for hemorrhagic stroke increased and two decreased. Among these, the PAF of ambient air pollution showed the largest increase (with average annual growth rates of 2.83%, 2.65%, and 2.90%, respectively), while the PAF of high-sodium diet showed the largest decrease (with average annual growth rates of –0.36%, –0.43%, and –0.16%, respectively).

Conclusions The burden of stroke among Chinese residents remained high from 1990 to 2019, with an increasing trend in DALY rates. High systolic blood pressure remained the leading risk factor for stroke and its subtypes.