The Evolving Burden of Stroke in China’s 832 Poverty-Alleviated Counties (2019-2024): Nationwide Spatiotemporal Analysis

Abstract

Abstract Background Stroke remains a leading cause of death and disability in China. Despite the 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 postpoverty 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 from 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 and average annual percentage change (AAPC). Spatial clustering was assessed using Global and Local Moran. Comparative analysis used age-standardized prevalence rates, referenced against the Global Burden of Disease 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 to 39 years (AAPC: +35.63%). Stroke incidence remained relatively stable from 2020 to 2023 but declined notably in 2024. While absolute prevalence remained lower, its growth rate in poverty-alleviated regions (+61.85%) far exceeded that in the nonpoverty-alleviated areas (+3.82%) during 2019 to 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 increased sharply in recorded prevalence, exhibited a worrying shift toward younger adults, and became geographically polarized. Economic advancement has not translated into proportionate health gains. These findings underscore the urgent need for precision public health interventions that are geographically targeted and demographically tailored to address this evolving epidemic.