Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 15, 2026
Date Accepted: Apr 30, 2026
The Evolving Burden of Stroke in China’s 832 Poverty-Alleviated Counties: A Nationwide Spatiotemporal Analysis (2019-2024)
ABSTRACT
Background:
Stroke remains a leading cause of death and disability in China. Despite nationwide poverty alleviation being achieved by 2020, residents of poverty-alleviated counties continue to experience poorer health outcomes. There is a critical knowledge gap regarding the evolving spatiotemporal patterns of stroke burden in this large, post-poverty population.
Objective:
This study aimed to quantify the longitudinal trends in stroke prevalence and incidence across all 832 poverty-alleviated counties in China from 2019 to 2024, stratified by age and sex; to characterize the spatiotemporal evolution and geographic clustering of the stroke burden; and to compare this burden in poverty-alleviated counties with that of the general Chinese population during the key transitional period of 2019 to 2021.
Methods:
We conducted a nationwide, retrospective analysis using data from China’s National Health Poverty Alleviation Dynamic Management System (NHPADMS), covering 56.08 million residents. Temporal trends were analyzed using Joinpoint regression to calculate the Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC). Spatial clustering was assessed via Global and Local Moran’s I. Comparative analysis employed age-standardized prevalence rates, referenced against the Global Burden of Disease (GBD) standard population.
Results:
Stroke prevalence surged markedly from 65.18 to 359.60 per 100,000 population (overall AAPC: +22.95%), with the steepest increase among adults aged 20-39 years (AAPC: +35.63%). While absolute prevalence remained lower, its growth rate in poverty-alleviated regions (+61.85%) far exceeded that in the non-poverty-alleviated areas (+3.82%) during 2019-2021. Spatial analysis revealed persistent hyperendemic clusters in northern provinces (notably the Hebei-Heilongjiang-Jilin-Inner Mongolia corridor) and a significant north-south gradient.
Conclusions:
The stroke burden in China’s poverty-alleviated counties is accelerating rapidly, exhibits a worrying shift toward younger adults, and is geographically polarized. Economic advancement has not translated into proportionate health gains. Findings underscore an urgent need for precision public health interventions that are geographically targeted and demographically tailored to address this evolving epidemic.
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