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Stroke burden in China and its association with metabolic syndrome: a nationwide cohort study and GBD analysis

Year: 2026
Type: article
Abstract: We examined stroke burden attributable to selected metabolic risk factors and associations between metabolic syndrome (MetS) scores and subsequently reported stroke. Global Burden of Disease 2023 data described stroke burden in China during 1990–2023 and disability-adjusted life years (DALYs) attributable to four metabolic risk factors. Two China Health and Retirement Longitudinal Study (CHARLS) cohorts included adults aged ≥ 45 years. Baseline Wave 1 score was related to first stroke reports at Waves 2–4. Cumulative mean score averaged Wave 1 and Wave 3 scores, with Wave 3 as time zero and Wave 4 outcomes among participants with known negative stroke status through Wave 3. Primary Model 2 logistic regression adjusted for demographic, behavioral, and baseline health characteristics. Restricted cubic splines and supplementary interval-censored survival analyses were performed. Age-standardized stroke incidence declined while absolute incident case numbers increased. In 2023, age-standardized incidence and DALY rates were 192.19 and 1,912.42 per 100,000 population. High systolic blood pressure accounted for the largest attributable stroke DALY burden among the selected factors. Baseline and cumulative analyses included 6,490 participants with 536 stroke reports and 3,702 with 241, respectively. Adjusted odds ratios per standard deviation were 1.19 (95% confidence interval, 1.09–1.30) and 1.24 (1.07–1.44). Baseline score showed nonlinearity ( P < 0.001), whereas cumulative mean score did not show statistically significant nonlinearity ( P = 0.337). No subgroup interactions remained statistically significant after Benjamini–Hochberg correction for multiple testing. Higher baseline and cumulative mean MetS scores were associated with subsequently reported stroke. The predictive and clinical value of repeated metabolic assessment requires prospective external validation. Not applicable.
DOI: 10.1186/s12872-026-06946-8
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7225831471
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