Comparative analysis of global and Chinese trends in the burden of ischemic stroke attributable to secondhand smoke from 1990–2021

Abstract

INTRODUCTION Ischemic stroke (IS) represents a major health burden in China, and tobacco control is recognized as a practical and effective strategy to alleviate this impact. This study examines the influence of secondhand smoke (SHS) on the IS burden in China from 1990–2021. METHODS Based on data from the Global Burden of Disease (GBD) 2021, this study analyzed the mortality and disability-adjusted life years (DALYs) burden of ischemic stroke (IS) attributable to secondhand smoke (SHS) in China and globally from 1990 to 2021. This study examined trends across different age and sex groups and projected future mortality and DALYs, providing a scientific basis for targeted public health strategies. RESULTS Over the past 32 years, the number of IS deaths from SHS exposure in China rose from 23394.83 (95% UI: 15837.47–32315.19) in 1990 to 53697.88 (95% UI: 35003.84–76382.65) in 2021. Despite this increase, the ASMR declined from 3.94 (95% UI: 2.59–5.54) per 100000 population in 1990 to 2.92 (95% UI: 1.88–4.21) in 2021, with an AAPC of -0.04 (95% CI: -0.04–0.03). However, China's ASMR and ASDR remain significantly higher than the global average. APC analysis revealed greater mortality trends among the elderly and females. Over the next 30 years, mortality rates will decline across all ages, but deaths will rise, especially in those aged 75 years and older. CONCLUSIONS The mortality rate of SHS-related IS in China declined from 1990 to 2021, but elderly and female patients still face a high burden. China’s disease burden remains higher than the global average. While mortality rates may continue to decline, deaths are expected to rise, especially among those aged 75 years and older.