Differences in the burden and temporal trend of stroke in the Belt and Road Initiative countries, 1990-2021

Q: What are the key findings of this study?

From 1990 to 2021, the age-standardized rates of incidence, mortality, YLDs, and DALYs due to stroke generally declined in most Belt and Road Initiative member countries, though absolute numbers remain enormous.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Stroke. Intervention: Time period 1990-2021. Primary outcome: Temporal trends (Average Annual Percent Change) of age-standardized incidence, mortality, YLDs, and DALYs of stroke.

Q: What does this research mean for the field?

Age-standardized rates of stroke incidence, mortality, YLDs, and DALYs generally declined across most Belt and Road Initiative countries from 1990 to 2021, though the absolute stroke burden remains high with substantial regional, age, and sex disparities. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Zheng Luo; Yue Zhang; Jinyi Wu; Xiaopan Li

doi:10.1515/med-2026-1532

January 1, 2026Open MedicineOpen Access

Differences in the burden and temporal trend of stroke in the Belt and Road Initiative countries, 1990-2021

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Key result

Stroke rates decline across Belt and Road countries since 1990, but total burden remains massive.

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Why the study?

Differences in the burden and temporal trends of stroke-related disability in Belt and Road Initiative countries from 1990 to 2021 were not well characterized.

Key Points

To evaluate differences and temporal trends in stroke incidence, mortality, and disability-related burden across Belt and Road Initiative member countries from 1990 to 2021.
Extracted stroke incidence, mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) across Belt and Road countries using Global Burden of Disease (GBD) 2021 data.
Applied Joinpoint regression analysis to calculate the average annual percent change (AAPC) for temporal trends in age-standardized stroke metrics between 1990 and 2021.
In 2021, China, India, and Indonesia had the highest absolute stroke burden; in China alone, there were 4.09 million incident strokes, 2.59 million deaths, 5.09 million YLDs, and 53.19 million DALYs.
Most countries demonstrated downward trends in age-standardized metrics, with China showing significant AAPC reductions in incidence (-0.37%, 95% CI: -0.44% to -0.29%, p<0.001), mortality (-1.79%, 95% CI: -2.01% to -1.57%, p<0.001), and DALYs (-1.93%, 95% CI: -2.09% to -1.77%, p<0.001).
Increases in age-standardized YLD rates occurred in select regions, peaking in men from Turkmenistan (AAPC=0.60%, 95% CI: 0.58% to 0.61%) and women from the Philippines (AAPC=0.57%, 95% CI: 0.55% to 0.59%).

Study Design

Type

Observational

Structured PICO

P

Population

Populations across 66 Belt and Road Initiative countries were analyzed using GBD 2021 data to assess the temporal trends and burden of stroke incidence, mortality, and disability from 1990 to 2021.

O

Outcome

Age-standardized rates and absolute numbers for stroke incidence, mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs)hard clinical

While age-standardized stroke rates have generally declined across the Belt and Road countries over three decades, the absolute burden of stroke remains enormous with significant regional and gender disparities.

Limitations

Subject to general limitations of the Global Burden of Disease (GBD) methodology.
GBD 2021 estimates reflect with-pandemic conditions where healthcare disruptions may have increased stroke mortality and disability.
Cause-of-death coding may have been influenced by a focus on COVID-19, potentially leading to misclassification.
Disability weights used to calculate YLDs may not be uniform across demographic and sociodemographic levels.
Significance tests for AAPCs were performed across multiple countries and indicators without formal multiple comparison corrections (e.g., Bonferroni).
Differences between countries may be partly explained by changes in the quality and completeness of available information.
Stroke burden was only analyzed at Level 1 risk categories and not disaggregated to Level 3 individual risk factors.

Implication

Persistent absolute stroke burden despite rate declines warrants sustained prevention efforts; leaves open targeted disparity research in Belt and Road countries.

Abstract

Objectives: To analyze the differences in the burden and trend of disability caused by stroke in "Belt and Road" ("B&R") countries from 1990 to 2021. Methods: We applied GBD 2021 to compare stroke incidence, mortality, the years lived with disability (YLDs) and disability-adjusted life-years (DALYs) from 1990 to 2021 in the "B&R" countries. The average annual percent change (AAPC) was used to analyze the temporal trends of age-standardized YLDs rate of stroke from 1990 to 2021 by Joinpoint regression analysis. Results: China, India and Indonesia had the highest absolute stroke numbers of stroke. From 1990 to 2021, the AAPC values of age-standardized metrics showed a downward trend in most of "B&R" countries. Turkmenistan had the highest increase in AAPCs of age-standardized YLDs rate for men (AAPC=0.60 %), while for women Philippines had the highest increase (AAPC=0.57 %). For under 15 years, YLDs due to stroke in most member states showed a downward trend, while increasing trends were noted in Saudi Arabia and Turkmenistan. Globally, metabolic, environmental/occupational and behavioral risk factors showed significant reductions (AAPC: -0.12 %, -0.92 %, and -0.53 %, respectively). Conclusions: The overall burden of stroke remains enormous, with regional, age and gender disparities. Enhanced health cooperation among B&R countries is warranted.

Discussion

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Cite This Study

Luo et al. (2026) conducted an observational in Stroke. Time period 1990-2021 was evaluated on Temporal trends (Average Annual Percent Change) of age-standardized incidence, mortality, YLDs, and DALYs of stroke. From 1990 to 2021, the age-standardized rates of incidence, mortality, YLDs, and DALYs due to stroke generally declined in most Belt and Road Initiative member countries, though absolute numbers remain enormous.

synapsesocial.com/papers/6ad0fd263afa093ea9ad026e https://doi.org/10.1515/med-2026-1532

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Differences in the burden and temporal trend of stroke in the Belt and Road Initiative countries, 1990-2021

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Differences in the burden and temporal trend of stroke in the Belt and Road Initiative countries, 1990-2021

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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