Trends and sex disparities in high BMI-associated ischemic stroke burden in China (1990-2021): Evidence from GBD and CHARLS analyses.

BACKGROUND

Ischemic stroke (IS) poses a major public health challenge in China, with a growing burden linked to high body mass index (BMI). This study analyzes trends and gender differences in the disease burden of high BMI-associated IS from 1990 to 2021.

METHODS

Using the GBD 2021 database, we assessed mortality, DALYs, YLDs, and YLLs. Methods included bibliometric analysis, decomposition analysis, joinpoint regression, age-period-cohort modeling, ARIMA forecasting, and multivariate logistic regression with CHARLS 2011 data.

RESULTS

Decomposition highlighted rate effects as the main driver of increasing stroke burden. All age-standardized rates (ASMR, ASDR, ASYLD, ASYLL) rose significantly from 1990-2021, with higher burdens in males. EAPCs ranged from 2.46% to 4.47%. A brief decline occurred during 2004-2007, followed by sustained growth. Men aged 40-80 faced significantly higher mortality risk. High BMI (≥25 kg/m²) raised stroke risk (OR = 1.36), especially in men (OR = 1.56), with actual incidence 56-70% higher than predicted.

CONCLUSION

The disease burden of high BMI-associated IS continues to rise, disproportionately affecting males. Targeted interventions-particularly for middle-aged and younger men-and integrated weight management are urgently needed.