Lifestyle-attributable burden of young-onset stroke in Chinese and global populations aged 20-54 years: A three decades comparative study (1990-2021) using Global Burden of Disease study data.

Introduction: Young-onset stroke represents a growing public health crisis globally along with rapid lifestyle changes. This study investigated the mortality and disability burden of young-onset stroke attributable to modifiable lifestyle factors in China compared with global trends, aiming to identify critical intervention targets.

Methods: Utilizing Global Burden of Disease 1990-2021 data, we analyzed age-stratified mortality and disability-adjusted life years for four lifestyle risk factors (tobacco, high alcohol use, dietary risk, and low physical activity). Temporal trends were assessed through joinpoint regression and age-period-cohort modeling, with population-attributable fractions compared between Chinese and global populations over three decades.

Results: China demonstrated persistently greater burdens from tobacco and high alcohol use than global averages did, particularly among males, where alcohol-attributable disability-adjusted life years (DALYs) increased 21% faster than mortality rates did. Gender disparities were prominent, with male population attributable fractions (PAFs) for alcohol exceeding female levels by 9.3-fold. Paradoxically, Chinese females presented rising low physical activity-related DALYs despite declining mortality. Midlife adults (aged ≥40 years) showed accelerated risk accumulation, whereas dietary risk reductions in China outpaced global declines by 2.4-fold. Age effects for all risks were weaker than global estimates, although period and cohort patterns aligned closely.

Conclusions: The diverging trajectories of mortality and disability burdens underscore China's dual challenge: curbing substance-related mortality in young males while containing midlife disability escalation. Culturally tailored strategies addressing gender-specific risk profiles and alcohol-DALY decoupling are urgently needed. These findings provide pivotal evidence for global stroke prevention in transitioning societies.