Objective  To analyze change trend in disease burden of stroke and its risk factors in China from 1990 through 2017 and to provide evidences for rational allocation of health resources and the development of targeted stroke prevention and treatment strategies.

  Methods  Data on disease burden of stroke during the period from 1990 through 2017 in China were extracted from the Global Burden of Disease (GBD) Study of 1990, 2000, 2010 and 2017. Years lived with disability (YLDs), years of life lost (YLLs), disability adjusted life years (DALYs) were used to evaluate the disease burden of stroke and population attributable fraction (PAF) was adopted to analyze risk factors of stroke-related disease burden. Disparities in disease burden of stroke between China and the world were compared.

  Results  During the period of 1990 – 2017 in China, the YLLs rate and DALYs rate of stroke increased gradually; the YLLs rate also increased generally but with a temporary decline in 2010. In 2017 in China, the age-specific YLDs, YLLs, and DALYs rate of stroke increased with the increment of age and the highest rates were observed among the population aged ≥ 70 years (2 617.2/100 000 for YLDs, 16 789.4/100 000 for YLLs, and 16 773.4/100 000 for DALYs); the YLDs rate was lower for the males than that for the females (475.5/100 000 vs. 530.9/100 000) but the YLLs and DALYs rate were higher for the males than those for the females (3 181.7/100 000 vs. 2 060.9/100 000 and 3 657.1/100 000 vs. 2 591.8/100 000); the age-standardized YLDs, YLLs, and DALYs rate of stroke were higher than those in the world (374.5/100 000 vs. 235.0/100 000, 1 967.8/100 000 vs. 1 422.2/100 000, and 2 342.3/100 000 vs. 1 657.2/100 000). Compared to those in 1990 in China, the age-standardized YLDs rate of stroke increased by 30.9%; while, the age-standardized YLLs rate and DALYs rate decreased by 38.8% and 33.1%; the change trend of the three rates were consistent with the changes in global stroke burden (5.9% for YLDs, = – 34.5% for YLLs, and – 30.7% for DALYs). Among the 16 risk factors associated with DALYs (million person-years), PAF, and DALYs rate of stroke, the top five were hypertension (24.974, 56.4%, and 1 768.1/100 000), excessive sodium intake (17. 060, 38.5%, and 1 207.8/100 000), insufficient fruit intake (10.717, 24.2%, and 758.7/100000), insufficient cereal intake (10.690, 24.1%, and 756.8/100 000), and smoking (10.037, 22.7%, and 710.6/100 000) for the population in China in 2017; from 1990 to 2017, PAF for the 10 of the 16 stroke risk factors increased and the other 6 decreased, with the highest increase (90.0%) for high body mass index and the greatest decrease ( – 71.3%) for indoor air pollution.

  Conclusion   In China, the disability caused by stroke is increasing gradually and although being effectively controlled, stroke-related premature death is still the main contribution of disease burden. Primary prevention strategies should be promoted to alleviate the disease burden of stroke.