The Evolving Premature Burden of Ischemic Stroke (GBD 2023) Among Adults Aged 50-69 Years in China, India, and the United States: A 34-Year Predictive Analysis Based on YLL/YLD Decomposition and ARIMA Models (1990-2053).

BACKGROUND: The younger onset of ischemic stroke creates a significant premature disease burden for adults aged 50-69. China, India, and the United States represent different stages of global epidemiological transition. We evaluate the spatiotemporal evolution of ischemic stroke burden, shifts in disease composition (fatal versus disabling), and dynamic trajectories of core risk factors in this demographic across the three countries from 1990 to 2023, with exploratory long-term scenario projections to 2053. METHODS: Based on the GBD 2023 database, we extracted DALYs, YLLs, YLDs, and PAFs for adults aged 50-69 in the three nations. ARIMA models were used to forecast the disease burden through 2053, with prediction intervals reported across multiple horizons to convey the widening uncertainty of long-range forecasts. RESULTS: Stroke burden trajectories among the three countries diverged significantly from 1990 to 2023. ARIMA scenario projections indicate that China's DALY rate will continue to decline, India's rate will remain approximately flat at its current high level, and the US rate will remain on a high plateau. India is projected to retain the highest DALY rate of the three countries throughout the 10-year horizon, though widening intervals indicate that long-range estimates should be interpreted as scenario-based projections rather than precise forecasts. Compositional analysis reveals that the US has shifted towards a high-disability pattern, characterized by an expanding proportion of YLDs. India remains dominated by a YLL-driven burden indicating high acute mortality. China exhibits a prominent sex disparity with a male-to-female burden ratio of nearly 2:1. High smoking rates among Chinese men have stalled the overall decline in disease burden. Meanwhile, India faces dual pressures from persistent particulate matter pollution (PM2.5) and escalating metabolic risks. the attributable risk of high body-mass index (BMI) in the US rose consistently over the past three decades, affecting both sexes equally. CONCLUSION: Stroke prevention for middle-aged and older adults requires tailored, region-specific strategies. China needs to enforce stricter tobacco control specifically targeting the male population. India faces systemic challenges ranging from upgrading primary energy structures to establishing robust cardiovascular screening networks. The US must strengthen national metabolic disease management.