# Trends and projections of smoking-attributable ischemic stroke mortality in China, 1990–2035: a global burden of disease study

## TL;DR

This study examines how smoking-related deaths from ischemic stroke in China have changed from 1990 to 2021 and predicts future trends up to 2035.

## Contribution

The study provides new projections of smoking-attributable ischemic stroke mortality in China using Bayesian age-period-cohort modeling.

## Key findings

- Age-standardized mortality declined more sharply in women than in men from 1990 to 2021.
- Bayesian projections suggest a slow decline in smoking-attributable ischemic stroke mortality through 2035.
- Older men may experience a mild plateau in mortality rates after 2030.

## Abstract

Smoking is a major modifiable risk factor for ischemic stroke and remains a significant public health challenge in China. Understanding long-term mortality trends attributable to smoking is essential for guiding prevention and policy interventions.

We analyzed smoking-attributable ischemic stroke mortality in China from 1990 to 2021 using data from the Global Burden of Disease (GBD) 2021 study. Temporal patterns were assessed using Joinpoint regression, and age, period, and cohort effects were evaluated using the age–period–cohort (APC) model. Future mortality trends were projected up to 2035 using a Bayesian APC model.

Overall age-standardized mortality declined from 1990 to 2021, with a sharper decrease in women (AAPC −2.65%) than in men (AAPC −0.58%). APC analysis showed increasing mortality risk with age and distinct cohort patterns between sexes. Bayesian projections indicate that smoking-attributable ischemic stroke mortality in China will continue to decline slowly over the next decade, with only a mild plateau after 2030 among older men but no substantial rebound.

Smoking remains a substantial contributor to ischemic stroke mortality in China, with persistent gender disparities. Although short-term declines are expected to continue, demographic aging and historical smoking patterns may slow future progress. Strengthened, targeted tobacco control strategies particularly for middle-aged and older men are essential to prevent a resurgence in smoking-attributable stroke mortality.