Abstract
BACKGROUND: Ischemic stroke (IS) persists as a major global health challenge. This study assesses IS burden, epidemiological trends, and associations with the Socio-demographic Index (SDI) across China and G20 nations (1990-2021), projecting trends to 2031 to inform resource prioritization. METHODS: Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and mortality-to-incidence ratio (MIR) using Joinpoint regression (trends), autoregressive integrated moving average (projections), and Pearson correlation (SDI linkage), stratified by age and sex. RESULTS: From 1990 to 2021, China experienced rising crude IS incidence (+27.4%) contrasting with G20 declines. Although ASMR and DALYs decreased globally, China's ASMR initially increased (1999-2004) before declining, unlike sustained G20 reductions. China's ASIR rose 35.7% versus a 15.6% G20 reduction. Projections indicate stable ASMR with rising ASIR in China, diverging from declining ASMR and stable ASIR in the G20. SDI-linked disparities persisted, with China's ASIR/ASMR exceeding G20 averages relative to SDI. CONCLUSIONS: China's distinct trajectory-characterized by rising incidence and delayed mortality decline-underscores the necessity for tailored interventions. Addressing SDI-driven disparities is essential for equitable global prevention and care strategies.