Table 1_Age-Period-Cohort analysis and 2036 projections of the burden of ischemic stroke in Finland, Korea, Singapore and China, 1990–2021.docx

ObjectiveTo analyze the temporal changes in ischemic stroke incidence and prevalence and their correlations with age, period, and birth cohort from 1990 to 2021 in Finland, Korea, Singapore and China, and to predict the trends of incidence and number of cases in 2036.
MethodsThe data from the Global Burden of Disease (GBD) 2021 database were used. The effects of age, period and birth cohort on the incidence of ischemic stroke were sorted out by age-period-cohort (APC) modeling. Bayesian Age-Period-Cohort (BAPC) modeling was used to predict the incidence rates of different sex and age groups in 2036.
ResultsThe global all-age disability-adjusted life year (DALY) rate of ischemic stroke decreased by 34.90% between 1990 and 2021, with the highest disease burden in China, especially in males. Whereas, Singapore, South Korea, and Finland were lower than the global average. The APC model showed that the incidence increased significantly with the increase of age. Compared with China, the age of high incidence in Singapore, South Korea and Finland has moved forward. In terms of period effect, there were fluctuations across the countries. Although China is less affected by the cyclical effect, the overall burden is increased. In the cohort effect, the incidence of Singapore, Finland, and Korea showed a “U-shape,” while China's prevalence continued to decline. Projections for the next 15 years indicate that the incidence rates in Finland, Korea, and Singapore will remain low, whereas China may continue to increase. By 2036, it could reach nearly 200 per 100,000 people, and the uncertainty is greater, so it needs to focus on prevention and control.
ConclusionThe burden of disease for ischemic stroke has been declining in all four countries from 1990 to 2021, but it has been rising in recent years and is expected to continue to rise over the next 15 years.

研究目的：分析1990至2021年芬兰、韩国、新加坡及中国缺血性脑卒中（ischemic stroke）发病率、患病率的时间变化趋势，及其与年龄、时期、出生队列的相关性，并预测2036年的发病趋势与患病人数。
研究方法：本研究采用全球疾病负担（Global Burden of Disease, GBD）2021数据库数据。通过年龄-时期-出生队列（age-period-cohort, APC）模型梳理年龄、时期及出生队列对缺血性脑卒中发病率的影响；采用贝叶斯年龄-时期-出生队列（Bayesian Age-Period-Cohort, BAPC）模型预测2036年不同性别及年龄组的发病率。
研究结果：1990至2021年，全球缺血性脑卒中全年龄伤残调整寿命年（disability-adjusted life year, DALY）率下降34.90%，其中中国疾病负担最高，尤以男性群体为甚；新加坡、韩国及芬兰的疾病负担均低于全球平均水平。年龄-时期-出生队列模型显示，发病率随年龄增长显著升高；与中国相比，新加坡、韩国及芬兰的高发年龄有所提前。在时期效应方面，四国均存在波动；尽管中国受周期效应的影响较小，但整体疾病负担仍呈上升趋势。在队列效应方面，新加坡、芬兰及韩国的发病率呈现“U型”分布，而中国的患病率则持续下降。未来15年的预测结果显示，芬兰、韩国及新加坡的发病率将维持在较低水平，而中国的发病率可能持续上升；至2036年，中国的发病率或可达每10万人近200例，且不确定性较高，因此需重点关注其防控工作。
研究结论：1990至2021年，四国的缺血性脑卒中疾病负担均有所下降，但近年来呈上升趋势，且预计未来15年将持续攀升。