Stroke attributed to kidney dysfunction from 1990 to 2021 and the prediction for 2040: an analysis of national data in China based on the Global Burden of Disease 2021 database.

backgroundStroke is the leading cause of permanent disability and death worldwide and the third leading cause of death in China, bringing a heavy disease and economic burden to the country. Notably, stroke mortality in China was significantly higher than the global level, highlighting the severity of the stroke problem in China. Kidney dysfunction has been associated with stroke risk, but the burden of stroke attributable to kidney dysfunction remains unclear. Our study aimed to systematically assess the burden of stroke and subtypes attributable to kidney dysfunction by analyzing the long-term trends from 1990 to 2021 in China, as well as making projections to 2040.

methodsRelevant data revealing burden estimates of stroke and subtypes attributed to kidney dysfunction were obtained from the Global Burden of Disease (GBD) 2021 database. To assess the burden of the disease, we appraised the age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life-year rates (ASDRs) by gender and stroke subtypes. Among them, kidney dysfunction-related stroke subtypes included ischemic stroke (IS) and intracerebral hemorrhage (ICH), while subarachnoid hemorrhage attributed to kidney dysfunction has an extremely low mortality and was therefore not included in the GBD database. Moreover, the average annual percentage change (AAPC) was applied to assess the overall trend from 1990 to 2021, and the effects of age, period, and birth cohort on stroke mortality due to kidney dysfunction were estimated using an age-period-cohort model. Furthermore, the Nordpred model was conducted to predict the mortality of kidney dysfunction related stroke and the subtypes for 2040 in China.

resultsIn China, the ASMRs of stroke attributed to kidney dysfunction decrease from 19.8 per 100,000 population in 1990 to 10.2 in 2021, with the AAPCs of -2.17 (confidence interval [CI], -2.50 to -1.84), and ASDRs declined from 393.0 in 1990 to 198.8 in 2021, with AAPCs of -2.22 (95% CI: -2.51 to -1.93). Regarding stroke subtypes, the ASMRs showed similar decrease trends from 6.9 to 4.9 for IS, and from 12.9 to 5.3 for ICH. The ASDRs were observed from 129.9 to 92.7 for IS, and from 263.1 to 106.2 for ICH. Moreover, the net and local drift curves indicated the proportion of stroke and IS mortality was rising among both younger (< 40-44 years) and older (> 70-74 years) age groups. Meanwhile, the proportion of ICH mortality increased in the age groups under 45-49 years old and over 80-84 years old. The longitudinal age curves revealed that stroke and subtypes mortality due to kidney dysfunction increased dramatically with age, particularly among the elderly. Significantly, men exhibited a higher mortality, while a more modest decline compared to women. Lastly, the projection modeling suggested that the ASMRs of kidney dysfunction-related stroke and the subtypes would continue to decline, and the kidney dysfunction-related ASMRs for IS would be higher than that for ICH by 2040 in China.

conclusionsKidney dysfunction was a significant contributor to stroke mortality in China, particularly in men and elderly. The downward trends suggested that the current prevention for stroke related to kidney dysfunction were effective. However, the ASMRs of IS associated with kidney dysfunction is expected to exceed that for ICH, highlighting further interventions to reduce the burden of IS in vulnerable populations.