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Abstract：
To estimate the rate of death, and disability-adjusted life years (DALYs) and project the disease burden of ischemic stroke due to relevant risk factors in young adults age 20-49 years by sex in China. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The age-standardized mortality (ASMR), age-standardized DALYs rate (ASDR), and estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trends from 1990 to 2019. We also used the NORDPRED model to predict ASMR for ischemic stroke due to related risk factors in Chinese young adults over the next 10 years. From 1990 to 2019, the general age-standardized mortality [from 2.39 (1.97 to 2.99) in 1990 to 1.8 (1.41 to 2.18) in 2019, EAPC = - 1.23] and DALYs rates (from 171.7 (140.34 to 212.36) in 1990 to 144.4 (114.29 to 177.37) in 2019, EAPC = - 0.86) decreased for ischemic stroke in young adults in China. ASMR and ASDR decreased for all level 1 risk factors (including behavioral, environmental/occupational, and metabolic) from 1990 to 2019, with the slightest decrease for metabolic risks [ASMR from 1.86 (1.39 to 2.41) in 1990 to 1.53 (1.15 to 1.92) in 2019, ASDR from 133.68 (99.96 to 173.89) in 1990 to 123.54 (92.96 to 156.98) in 2019] and the largest decrease for environmental/occupational risks [ASMR from 1.57 (1.26 to 1.98) in 1990 to 1.03 (0.78 to 1.29) in 2019, ASDR from 110.91 (88.44 to 138.34) in 1990 to 80.03 (61.87 to 100.33) in 2019]. In general, high body-mass index, high red meat intake, and ambient particulate matter pollution contributed to the large increase in ASMR and ASDR between 1990 and 2019. Significant reductions in ASMR and ASDR were observed in low vegetables intake, household air pollution from solid fuels, lead exposure, and low fiber intake. In addition, there were sex differences in the ranking of ASMR attributable to risks in ischemic stroke. The disease burden of ischemic stroke attributable to relevant risk factors in young adults in China is greater and has a faster growth trend or a slower decline trend in males than in females (except for secondhand smoke). The apparent increasing trend of ASMR attributable to high fasting plasma glucose, high systolic blood pressure, high body-mass index, and high red meat intake was observed in males but not in females. The projected analysis showed an increasing trend in ASMR between 1990 and 2030 for all specific metabolic risks for males, but a decreasing trend for females. ASMR attributable to ambient particulate matter pollution showed an increasing trend from 1990 to 2030 for both males and females. The burden of ischemic stroke in young adults in China showed a downward trend from 1990 to 2019. Specific risk factors associated with the burden of ischemic stroke varied between the sexes. Corresponding measures need to be developed in China to reduce the disease burden of ischemic stroke among young adults.
摘要：
估计死亡率,和残疾调整生命年(DALYs)，并预测中国20-49岁青壮年缺血性卒中相关危险因素的疾病负担。来自全球疾病负担的数据，受伤,并使用2019年风险因素研究（GBD）。年龄标准化死亡率(ASMR)，年龄标准化DALYs比率(ASDR)，并计算了估计的年度百分比变化(EAPC)，以评估1990年至2019年的时间趋势。我们还使用NORDPRED模型预测未来10年中国年轻人缺血性卒中相关危险因素的ASMR。从1990年到2019年，中国年轻人缺血性卒中的一般年龄标准化死亡率[从1990年的2.39（1.97至2.99）下降到2019年的1.8（1.41至2.18），EAPC=-1.23]和DALYs率（从1990年的171.7（140.34至212.36）下降到2019年的144.4（114.29至177.37），EAPC=-0.86）。ASMR和ASDR在所有1级危险因素(包括行为，环境/职业,和代谢）从1990年到2019年，代谢风险略有下降[ASMR从1990年的1.86（1.39至2.41）下降到2019年的1.53（1.15至1.92），ASDR从1990年的133.68（99.96至173.89）下降到123.54（2019年的92.96至156.98）]，环境/职业风险下降最大[ASMR从1990年1.57（1.26至1.总的来说,身体质量指数高,红肉摄入量高，和环境颗粒物污染导致1990年至2019年ASMR和ASDR大幅增加。在低蔬菜摄入量中观察到ASMR和ASDR显著减少，固体燃料造成的家庭空气污染，铅暴露,和低纤维摄入量。此外,可归因于缺血性卒中风险的ASMR排序存在性别差异.我国青壮年缺血性卒中相关危险因素的疾病负担较大,且男性较女性有较快的增长趋势或较慢的下降趋势(二手烟除外)。ASMR的明显增加趋势归因于高空腹血糖，高收缩压,身体质量指数高,在男性中观察到较高的红肉摄入量，而在女性中没有。预测分析显示，在1990年至2030年间，男性所有特定代谢风险的ASMR呈增加趋势，但女性的下降趋势。从1990年到2030年，男性和女性的环境颗粒物污染引起的ASMR呈增长趋势。从1990年到2019年，中国青年缺血性卒中负担呈下降趋势。与缺血性卒中负担相关的特定风险因素因性别而异。我国需要制定相应的措施来降低青壮年缺血性脑卒中的疾病负担。
