Stroke disability burden and rehabilitation service-capacity proxies in China, 1990–2023: A population-based analysis using GBD 2023 and national service statistics
- 1Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- 2Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
Abstract
China’s stroke burden is increasingly shaped by survival with disability, population ageing, and demand for rehabilitation and long-term support. Yet the extent to which stroke disability burden has shifted towards older-old and oldest-old adults, and how this burden relates to community and elder-care service capacity, remains insufficiently quantified. We conducted a population-based secondary analysis of Global Burden of Disease Study 2023 estimates for China from 1990 to 2023, focusing on ischaemic stroke and intracerebral haemorrhage. We examined disability-adjusted life years (DALYs), years lived with disability (YLDs), YLD share of DALYs, age-specific patterns among adults aged 50 years or older, estimated annual percentage changes (EAPCs), and three-factor decomposition of absolute DALY changes. We also linked 2023 stroke YLDs with national community health and elder-care service indicators as descriptive capacity proxies. From 1990 to 2023, the YLD share of DALYs increased from 10.5% to 22.3% for ischaemic stroke and from 1.8% to 3.3% for intracerebral haemorrhage. The crude all-age ischaemic stroke YLD rate increased by 2.75% per year (95% CI 2.68 to 2.82), while the crude all-age intracerebral haemorrhage DALY rate declined but its YLD rate and YLD share increased. Crude all-age rates were interpreted as population-level burden indicators influenced by population age structure, alongside age-stratified and decomposition analyses. Among adults aged 50 years or older, disability burden shifted towards older-old and oldest-old groups, particularly for ischaemic stroke. In 2023, combined all-age YLDs from ischaemic stroke and intracerebral haemorrhage were approximately 4.77 million, corresponding descriptively to 128.2 YLDs per community health service centre/station and 16.7 YLDs per community health bed. Stroke in China is increasingly a survivorship and disability challenge. The burden-to-capacity proxy indicators provide planning context but do not directly measure rehabilitation access, adequacy, quality, or unmet need.
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BibTeX
@article{zhou2026stroke,
title = {{Stroke disability burden and rehabilitation service-capacity proxies in China, 1990–2023: A population-based analysis using GBD 2023 and national service statistics}},
author = {Yumin Zhou and Wenke Fan and Dandan Lv and Qian Li and Yu Cao and Hao Tian and Weiwei Guo and Xia Bi},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0361758},
url = {https://doi.org/10.1371/journal.pone.0361758},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stroke disability burden and rehabilitation service-capacity proxies in China, 1990–2023: A population-based analysis using GBD 2023 and national service statistics
AU - Yumin Zhou
AU - Wenke Fan
AU - Dandan Lv
AU - Qian Li
AU - Yu Cao
AU - Hao Tian
AU - Weiwei Guo
AU - Xia Bi
PY - 2026
DA - 2026/11/06
JO - PLOS One
DO - 10.1371/journal.pone.0361758
UR - https://doi.org/10.1371/journal.pone.0361758
AB - China’s stroke burden is increasingly shaped by survival with disability, population ageing, and demand for rehabilitation and long-term support. Yet the extent to which stroke disability burden has shifted towards older-old and oldest-old adults, and how this burden relates to community and elder-care service capacity, remains insufficiently quantified. We conducted a population-based secondary analysis of Global Burden of Disease Study 2023 estimates for China from 1990 to 2023, focusing on ischaemic stroke and intracerebral haemorrhage. We examined disability-adjusted life years (DALYs), years lived with disability (YLDs), YLD share of DALYs, age-specific patterns among adults aged 50 years or older, estimated annual percentage changes (EAPCs), and three-factor decomposition of absolute DALY changes. We also linked 2023 stroke YLDs with national community health and elder-care service indicators as descriptive capacity proxies. From 1990 to 2023, the YLD share of DALYs increased from 10.5% to 22.3% for ischaemic stroke and from 1.8% to 3.3% for intracerebral haemorrhage. The crude all-age ischaemic stroke YLD rate increased by 2.75% per year (95% CI 2.68 to 2.82), while the crude all-age intracerebral haemorrhage DALY rate declined but its YLD rate and YLD share increased. Crude all-age rates were interpreted as population-level burden indicators influenced by population age structure, alongside age-stratified and decomposition analyses. Among adults aged 50 years or older, disability burden shifted towards older-old and oldest-old groups, particularly for ischaemic stroke. In 2023, combined all-age YLDs from ischaemic stroke and intracerebral haemorrhage were approximately 4.77 million, corresponding descriptively to 128.2 YLDs per community health service centre/station and 16.7 YLDs per community health bed. Stroke in China is increasingly a survivorship and disability challenge. The burden-to-capacity proxy indicators provide planning context but do not directly measure rehabilitation access, adequacy, quality, or unmet need.
SN - 1932-6203
ER -